P2409 Jack Booe Rd " DAVIE COUNTY HEALTH DEPARTMENT �u l� , IglAl
a IMMOVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NotI'
t- F in Compliance with G.S. of North Carolina Chapter 130—Article 130,
,r Permit Number
Name �� Date - s
Location , , _
Subdivision Name -- Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms _ No. Baths No. in Family
Garbage Disposal YES ❑ NO p Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES 0 "'NO -❑
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Type Water Supply
*This permit Void if sewage system described below.is not installed within 36 months from date of issue.
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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 Installed by��1
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Certificate of Completion 1 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.
3
DAVIE COUNTY HEALTH DEPARTMENT i{r
IM-MOVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`No �- in Compliance with G.S. of North Carolina Chapter 130-Article 13c.
. P P
Permit Number
r► ` Date
Name
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size _ House Mobile Home _ Business __ Speculation
No. Bedrooms 'A` No. Baths —./ No. in Family
Garbage Disposal YES ❑ NO E]--- .M_ Specifications for System:
Auto Dish Washer YES ❑ NO p
Auto Wash Machine YES ❑,—NO ❑
Type Water Supply
1.
"This permit Void if sewage system described below is not installed within 36 months from date of issue.
J-5 ` I
.k r
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.
r
Final Installation Diagram: System Installed by�?� sI j��'i �� l}��'t� �✓
� �d'tlt:�3 ice* Or; 1 Ali;:;.• :>
s
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.
DAVIE COUNTY HEALTH DEPARTMENT
(Septic :Tank) Improvements Permit and Certificate of Completion
)Ground Abisorption/S/wage Disposal System - G.S. Chapter 130-Article 13C)
OWNER C CONTRACTORr DATE PERMIT
LOCA�ON .� - , �, ,- - . -- N° 1855
Aa,/7 777,77 !i r�'.. 7777- 11777-e-- S.R. N O.
SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO.
HOUSE ❑ -MOBILE HOME BUSINESS ❑
House Trailer 800 Gal. 400 Sq. Ft.
NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO 2---' Three Bedroom House 900 Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES C3 _W Four Bedroom House 1000 Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES 0�'A0 ❑
SITE SUITABLE YES a NO ❑
SIZE OF TANK ]le
gal.
NITRIFICATION FIELD sq. ft. 1
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual . Public ❑
IMPROVEMENTS PERMIT BY :` ''�•+ ' `' INSTALLED BY
CERTIFICATE OF COMPLETION By Date
(8/16/73) *Construction must comply with all other applicable State and local regulations
LOT AREA
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DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
. (704) 634-5985
Statement for Septic Tank Improvement Permits
and/or' Site Evaluations '
NAME DATE ISSUED
ADDRESS -:`'. PERMIT NO�
Explanation of' charge �
AMOUNT D7 SANITARIAN_
PLEASE REMIT THE ABOVE AHOUNT. 'ON RECEIP STATEMENT.