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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
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name n c�i `cam
1- Date y c�� { �'` �'
�— Date 1;3`; 37
Location
SubdivisionName
Lot No. Sec. or Block No.
Lot Size�'-' b •``"House �r Mobile Home _ Business Speculation
No. Bedrooms 3 No. Baths No"'in Family 4 _
Garbage Disposal r `YES p NO Specifications for System: ! i
Auto Dish Washer YES d NO,-p_ Q
Auto Wash Machine YES NO
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 -
S w -�rj
Certificate of Completion Date C6\
'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
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Jr
Name s , c_�� < <, c�T Date
Location '
Subdivision Name\_ Lot No. Sec. or Block No.`"�
Lot Size House �/ Mobile Home Business Speculation
No. Bedrooms 3 No. Baths No. in Family
Garbage Disposal YES ❑ NO Specification for' System:
Auto Dish Washer '-YES ff NO ❑
Auto Wash Machine YES Qa NO ❑
Type Water Supply .z \,j
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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.
Final Installation Diagram System Installed by
UJ ,JJ
Certificate of Completion`~ " � —`* Date b_
"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.
INFORAON FOR SEPTIC SYSTEM REPAIR PERMIT
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' "1 NAME /���C U �dcz--tom' PHONE NUMBER
ADDRESS �o�C / SUBDIVISION NAME
SUBDIVISION LOT #
DIRECTIONS TO SITEij
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e- A4 C froSS l T k- koe OIL r . C-I"a55
e eS �, e
DATE SEPTIC SYSTEM INSTALLEDQ S I (4, S
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDERP�`�rU
SPECIFY PROBLEMS THAT ARE OCCURRING Jl of' r-a i m ► u q q6d • 4o
DATE REQUESTED-41-J,?- g INFORMATION TAKEN BY LL/ U