330 Joe Rd o'b
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Se.wage Treatment and Disposal Rules (10 NCAC 10A .1934-.11968) Permit Number
Name \"�
V�- Date
N2 5722
Location \74 �,
E st
Subdivision Name of No. Sec. or Block No.
Lot Size House Mobile Home -- Business Speculation
No. Bedrooms No. Baths No. I-wFamily-7,
Garbage Disposal YES 0, NO a>e
Specifications for System:
Auto Dish Washer YES El NO IV,.'
Auto Wash Machine h YES,U/'- NO C]
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 represeffitive 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;d of completion. Telephone Number: 704-634-5985. .. .
Final Installation Diagram: System Installed by
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Certificate of Completion C 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 ;
*NOTE: Issued.in Compliance with G.S. of North Carolina Chapter 130 Article 13c
cS6;age Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit. Number
Name \`� �-�e �i`Cc�� N 5 Date c1 ' a� - x`1 N2 5722
Location 11 \�\ o c.Ks v ���"k ,Q,- t
�s S o��
Subdiv%ision Name of No. Sec. or Block No.
Lot Size ` 2 :Ck House Mobile Home Business Speculation
No. Bedrooms 3 No. Baths No. in Family _
Garbage Disposal YES ❑ NO [ y -Specifications for System:
Auto Dish Washei r YES ❑ NO XD
Auto Wash Machine YES:p/ NO ❑ x 3 1 I;.�ti�
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
1
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. . Improvements permit by
s
*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 bycz
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' 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.
WORKSHEET FOR SEPTIC 'SYSTEM REPAIR PERMITG�Q
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NAME - PHONE NUMBER
ADDRESS �ax SUBDIVISION NAME
,p SUBDIVISION LOT#
DIRECTIONS TO SITE 6`�'�' •,,1 -�T����T� -S�R� �y��� dJ�
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DATE SYSTEM INSTALLED o �s "
NAME SYSTEM INSTALLED UNDER /A
SPECIFY PROBLEMS OCCURRING
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DATE RECUESTED 9/0INFORMATION TAKEN BY Y
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