579 Deadmon Rd DAVIE COUNTY HEALTH DEPARTMENT
IMPkOVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a F �
Sanitary Sewage Systems Permit Number
Name C �s 2 Date J J � 1 D N� ' . --5992
Location V` �<sv Q '.' �J �. T- .
6 0
Subdivision Name Lot No./ Sec. or Block No.
Lot Size ,House Mobile Home _V Business_` Speculation
No. Bedrooms P No'. Baths No. in Family'
Garbage Disposals YES ❑ NO Specifications for,.System:
Auto Dish Washer- YES ❑ NO p" 1 ,
Auto Wash Machine YES NO ❑ N41
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Type Water. Supply
*This permit Void ff`sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
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E.
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 Instal lation.Diagram: System Installed by %2� Ih\
Fa v ~7
Certificate of Completion Date 9's
*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.
- DAVIE COUNTY..HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
. n
*NOTE;Issue in Compliance With Article_ 11 of G.S.Chapter 130a
'!§anitary Sewage Systems Permit Number
'-Name Date !
Location
C \ < moo'?
Subdivision Name Lot No. Sec. or Block No.
Lot Size "' ,:House Mobile Home _� Business Speculation
No. Bedrooms No. Baths f No. in Family —
Garbage Disposal " YES-0 NO Specifications for.System:
Auto Dish Washer .. YES p. NO ®'•
Auto Wash Machine YES Q3�/NO Q
Type Water Supply
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
Y F
f
C �
U°
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 ., 1`�.� � ° ��qt-R_
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too J
,,• �.
• Certificate of Completion �- ����� Date � �� 9
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 tom„el a„ cy PRONE NUMBERli
q g • g 1 [�2
ADDRESS 4. `7 g Q,� 3 e� SUBDIVISION NAME
V►1 d v.I h K c_
SUBDIVISION LOT 0
DIRECTIONS TO SITE (ooI5 - T l��-� 'D.ce�wie� - S�'\•1acs c. t1c,i� �o 5��..e
a_�-
• DATE SEPTIC SYSTEM INSTALLED ?
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING 4b 4ima a_F rou
DATE REQUESTED _ �.E _ c�p INFORMATION TAKEN BY