221 Gray Sheeks Rd ' 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
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name Date
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Location ��
Subdivision Name Lot No. Sec. or Block No.
Lot Size House _ I� •`•Mobile Home _ BusWess— Speculation
No. Bedrooms _ Ni?. Ba�hs^-� No. in Family `-', _
Garbage Disposal,,,, YES ❑ NO ❑ 4
}L Specifications for System:
Auto Dish Washer YDS ❑ NO"'❑ t G
Auto Wash Machine YES p1 NO ❑ G: a00
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��� CLA-&•4
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Certificate of Completion v•` brJ' Date 7✓Z g 7
*The signing of this certific a shall indicate that the system descri ed above has been installed in compliance with
the standards set forth in th 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 4 -
�. 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 r�� �.�c' -�, Date - -7)
f
7.
Location �; \ «T_i A 0 ." \N c. —
Subdivision Name Lot No. Sec. or Block No.
Lot Size 92 House `Mobile Home _ Business.—_ Speculation
4 .
No. Bedrooms �_ No. Baths No. in Family
Garbage Disposal,,, AYES ❑ NO ❑ Specifications for System: ,
Auto Dish Washer YES ❑ NO ❑ r �_` C�,1a
Auto Wash Machine YES :❑S NO ,0
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
i
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Irl
rQ"\C I��~t k. 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 by _d)'t,C''`k
1 C,
f '
Ij
� a
s
1 V
Certificate of Completion — 1 Date
*The signing of this certificto shall indicate that the system described above has been installed in compliance with
the standards set forth in tht 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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INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
" NAME �'. �• B Ia IocK PHONE NUMBER
ADDRESS ��, � �,� g SUBDIVISION NAME
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SUBDIVISION LOT #
DIRECTIONS TO SITE /SE1- j.leA4 S',?. /f�5/ L ,ius4 iFoe- &uA r
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED 7INFORMATION TAKEN BY