1808 County Line Rd w.
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DAVIE COUNTY HEALTH DEPARTMENT ,
' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION j f �
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934`-.19}68) Permit Number
1A
�_ ,� �. !~ � C1c 1_t ^ � :.1� 51 '33
Name ` 7 P. Date
Location `
Subdivision Name Lot No. Sec. or Block No.
Lot Size Housey Mobile Home _ BusinessSpeculation
No. Bedrooms L No. Baths No. in Family
Garbage Disposal` YES ❑ NO Specifications for System:
c �
Auto Dish Washer YES l NO ❑
Auto Wash Machine YES d NO ❑
Type Water Supply _—
*This permit Void if sewage system described below is not installed within,36 months from date of issue.
t
Improvements permit by .
*Contact a representative of the Davie County Health Department for final ,inspection of this system between. 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installedby
�rtificateof Completion – Date S5 —
'The signing of this certificate shall indicat that the s stem described above has been installed in compliance with
the standards set forth in the above regulation, ut s a in wayrauarantee that the system will function .
satisfactorily for any given period of time.
v.�.N -r ..•..�i..-�.._._.".-. ..,....." .—A. F..c•' e. ..-c"M:9— ,. , ti a - .--�.'.", .. y _F u+ .,t,. . .. �t...�•- ...- ..... - l_`_ DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC_.10A .1934`--:1968) Permit Number
Name Date
Location ��• i _
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms — No. Baths n No. in Family_=1
_--
Garbage Disposal YES ❑ NO Specifications for System:
..}
Auto Dish Washer YES lL/ NO ❑
Auto Wash Machine YES E NO ❑ U U I
Type Water Supply ^� _--
"This permit Void if sewage system described below is not installed within.36 months.from date of issue.
1
1 •
e
1,
Improvements permit by - IL -
`Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of omple tion. Telephone Number: 7047634-5985.
Final Installation Diagram: System Installed b
e /
i
C
cate of Completion ��1i� Date
'The signing of this certificate shall indicaat the system described above has been installed in compliance with
the standards set forth in the above regulation, ut shall in NO 9 a guarantee that the system will function
satisfactorily for any given period of time.
c _ a
` INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT 7y PS �V?"1
NAMEAl .. Ila PHONE NUMBER X92 l2 p'2 V v
ADDRESS ,� /: ,8 37 SUBDIVISION NAME
SUBDIVISION LOT #
DIRECTIONS TO SITE ZAA ,fe1/• - ,(J�1✓r J' 4,
r /r/ -i-, LONw - X4i a ogiAS/ eoJwcZVc o//ry " v 2rZ•
lMLG :P�lls✓ O'�/`i:/G!!. — '%/'y it C'�/� .1/C� Y'.�D �i�ty /r0 .s�
Q .4y.,, asp
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUEST6 y/f�� �� INFORMATION TAKEN BY