636 County Line Rd DAVIE COUNTY HEALTH DEPARTMENTG o
IMPROVEMENTS PERMIT AND. CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter130 Article 13c
--Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name ���� a , � :� � .L� rl Date N2 (�rG
Location ^ca -. , .
p i
IN,
Subdivision Nam�1e- Lot No. Sec. or Block No.
Lot Size _ " La ��'�-'� `House Mobile Home Business Speculation
No. Bedroomsr
J No'''Baths_�_'Nb. in Family. )-
`' -
Garbage Disposal YES p NO"cu/ a w: Specifications for System:
Auto Dish Washer '.,YES p NO.{ ,r.
Auto Wash Machine YES'p' NO .� %. ^►,
Type Water Supply , ....__
*This permit Void if sewage system describedµbelow is not installed within 36 months, from date of issue.
- l J
;M
�Improvements permit by
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`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 Installed by
Certificate of Completion ` � � Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
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DAVIE ;COUNTY HEALTH DEPARTMENT `��
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`'DOTE:Issued in Cofhpliance withi G.S .of North Carol ina,Chapter,"130 Article 13c
.%Sewage Treatment and Dispo9al Rules (4"CAC lOX..1934-.1968) Permit Number
;> Name 'a .3 ' -�'r: F.0 z� Date N2
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size �"�1 �� � House t✓f Mobile Home _ Business Speculation
r r)
No. Bedrooms,-- No:'Baths No. in Family,. ---
Garbage Disposal M'' `YES•[ ,NO a,, Specifications for ystem:
Auto Dish Washer AYES,❑ NO,t t) - ,
Auto Wash Machine YES o[p',�,;`NO {] U v`
Type Water Supply j
`This permit Void if sewage system described below is not installed within 36 months from-date of issue.
Improvements permit by •V.
*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 InstallaOri Diagram: ;System Installed by
i
J.
V Certificate of Completion Date
Date G ~�
"The signing of this certificate.shall indicate that the system described above has been installed in compliance with
the standards set forth in the above regulation-but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
NAME Pk!ar%ec PHONE NUMBER `,C12- SSSa
ADDRESS 1 SUBDIVISION NAME ^—
�-1a� . �... Y%.c- z4'1.3 4
SUBDIVISION LOT 0 i-
DIRECTIONS TO SITE 0 1 Cdr►.,...,,. l.k 1� - "�'• f2�-
T `
v DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
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DATE REQUESTED 6 - 2.6 -99 INFORMATION TAKEN BYE_