3029 Hwy 801S DAVIE COUNTY HEALTH DEPARTMENT
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IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Se ge Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) _ Permit Number
Name ��,�5 Date 2) N2 5492
Location DO 0rs
Subdivision Name Lot No. Sec. or Block No.
hh L
Lot Size d� �e �' t:House Mobile Home _ Business Speculation
No. Bedrooms _ No. Baths_ No. in Family_ <
Garbage Disposal YES ❑ NO Ug,-" ': ` Specifications for System:
Auto Dish Washer ` YES ❑ �1�10 g,
Auto Wash Machine YES ❑ NO S;
Type Water Supply W-"4 C,a. a°"
*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 �.
Y .
W `�+
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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•40" 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 issued,
Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
NaDate �) " 1 ' N2- 4 2
Location Yvt .-.i, U
Subdivision Name Lot No.-- ---Sec. or Block No.
L
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths 1 No. in Family
Garbage Disposal YES ❑ NO p/
Specifications for System:
Auto Dish Washer YES ❑ NO p-- �J
Auto Wash Machine YES ❑ NOWA
Type Water Supply _ 3 �!
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
0 o
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 Installed bye \-
Certificate of Completion -4- 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:
NFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
NAME ?, ,e a 61es PHONE NUMBER
ADDRESS I'2�' Z, $r� qQO SUBDIVISION NAME
�}dy armee , h C L-76 o&
SUBDIVISION LOT #
DIRECTIONS TO SITE 2,1/2. - 3 n,j.64, _ r;c.IL h✓u5-e�
dv-`�� C Sem:is 3 w 1 b•Fe,&) - Y\*-a ca-AA. �"� � ..� d v,�.r+-
DATE SEPTIC SYSTEM INSTALLED d"—
NAME
" -NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED 3- Z$' INFORMATION TAKEN BY _,