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1701 Hwy 64W DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Systems Permits Number Name �>- �, 4 9. ��_ �� Date � N2623 U 7"* Sub �isioname Lot No. Sec. or Block No. Lot Size we House - Mobile Home —T Business Speculation No. Bedrooms _.No.' Baths No-in Family Garbage Disposal YES ©' NO ❑ Specifications for System: - o- Auto Dish Washer`' L YES p,, NO p� Auto Wash Ma.hine YES p�NO ❑ ��p 3 X ' �' Type Water Supply o U *This permit Void if sewage system,described below is not installed within 5 years from date of issue. This permit is subjecf to revocation if site plans or the intended use change. �u F'r, i a / I J 1 I 1 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 Certificate of Completion - Date-;7)/i12- "The ate ) 2*The signing of this certificate shall indicate that the system described above has been installed in compli nce 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. 7 711; -, DAVIE COUNTY HEALTH DEPARTMENT �� IMPROVEMENTS PERMIT AND .CERTIFICATE` OF COMPLETION NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a -Sanitary Sewage Systems r Permit Number Name `0 -\ .. . �_w C, , .. Date NO 66CC 23\ Location ''\,. �'.. � ��Sc �•�� t.� �, `l Subdivision Name Lot No. Sec. or Block No. Lot Size CN-. House �/� Mobile Home _T Business Speculation No. Bedrooms No. Baths No. in Family _ Garbage Disposal YES p- NO ❑ Specifications for System: q Auto Dish Washer. YES,[] NO +CY" Auto i Nas :Ma.hive YES &--NO ❑ ��� � 3� `' Type Water Supply o U *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. 1 i f' it r I i - i ,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. A Final Installation Diagram: System Installed by ^ P11 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. -INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT v "NAME ,Ca` /�� �G��Yl�7t'T PHONE NUMBER ADDRESS `jQ� , /_ /�o�C �b SUBDIVISION NAME tv SUBDIVISION LOT # DIRECTIONS TO SITE Co 4 3 A.0 r yl DATE SEPTIC SYSTEM INSTALLED tjr.5 - NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER SPECIFY PROBLEMS THAT ARE OCCURRING f/ h e-- 11L A L L e 4,z�c, - DATE REQUESTED INFORMATION INFORMATION TAKEN BY