253 Dulin Rd DAVIE. COUNTY HEALTH DEPARTMENT t I
IMPROVEMENTS,,PERMIT AND CERTIFICATE OF COMPLETION*NO "`sV
/ TE: 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
ame -.c�9.►. r�� Date j 4967
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home,_ Business Speculation
No. Bedrooms No. Baths
No. in Family
Garbage Disposal YES ,.E] NO ` tj Specifications for System:
Auto Dish Washer YES ❑ 'NO
Auto Wash Machine YES O/ NO .❑ i d o' X x
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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yImprovements permit by Z � �
*Contact a representative of the DavieJCounty 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 � � �ASUAT.
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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.
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DAVIE COUNTY HEALTH DEPARTMENT ; J _V
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 !i- ,
r ,r r
` 4 906 7
Location —
Subdivision Name Lot No. Sec. or Block No.
Lot Size - -"- -'< House Mobile Home _ Business'_— Speculation
No. Bedrooms r`J No. Baths No. in Family��—
Garbage Disposal YES ❑ NO .fl Specifications for System:
Auto Dish Washer YES ❑ NO `
Auto Wash Machine YES NO ❑ /1 a y ?t, ti
Type Water Supply ,
`This permit Void if sewage system described below is not instal,ed within 36 months from date of issue.
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.
1
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Final Installation Diagram: I System Installed by
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i
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
gie --73
( . NAME �+ hh f r PHONE NUMBER 4
� ADDRESS J�`f j ,. �& �/J SUBDIVISION NAME
SUBDIVISION LOT #
DIRECTIONS TO SITE _ 0-k d o)1�-A
DATE SEPTIC SYSTEM INSTALLED d'Z zi)
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING ,
d Ile � Gly S 1 h �jc2�"/�- 1—o d
DATE REQUESTED / a���� INFORMATION TAKEN BY 1i(/ �