1067 Milling Rd (2) DAVIE COUNTY &H 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 u tia �i P, �e Date '( " a N2 5760
Location 'r
\J13 111�,StJN\
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Subdivision Name Lot No. Sec. or Block No.
Lot Sizeerr House�—%Mobile Home _ Business — Speculation
No. Bedrooms ` No. Bath§ No. in Family_
Garbage Disposal YES 0 . NO � ' i� �
``�� Specifications for �ystem: ��
,;
Auto Dish Washer { ,,•,.YES p' NO p a +,E, O ► ►r�.• ;;,,
Auto Wash Machine YES NO
Type Water Supply
*This permit Void if sewage system described belpw is not installed',within 86 months from date of issue.
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Improvements permit by� _� °-'� �" • -'
*Contact a rei3resentative"of°the Davie County Health Department for .final inspectioq, of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on.day of corimpletion. Telephone Number:704-634-5985.
Final Installation Diagram: System Installed by
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Certificate of Completion \ . � Date
*The signing of this certificate shall indicate that the system described above has bean 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.
WORKSHEET FOR SEPTIC -SYSTEM REPAIR PERMIT
NAME K,t4klee,% l-�444 b3ti- 57aD—
PHONE NUMBER
ADDRESS �- SUBDIVISION NAME
Alctp,svA—
SUBDIVISION LOT#
DIRECTIONS TO SITE
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DATE SYSTEM INSTALLED " aL't At'd
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING S�`°F"" 5
DATE ,REQUESTED INFORMATION TAKEN BY�—
4+u.r.«...w.e;.i:.e-- .st;'� ,...e..:,.;. ,e,_:i w'.t-"... «:+tv+'.73sq•s:,::,�- .,,,� .._ � _ M r . r..vr _,,. F r .., - -.
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���-.•.�t�� ���. 1.:, , _ •, -c DAVIE COUNTY fjH DEPARTMENT, }'E
IMPROVEMENTS PERMIT AND CERTIFICATE OF :COMPLETION`
NOTE y'Issugd-in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and ,Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
-r Name�� ���'�N t 1 N T Date �� - `�� Np
:Location
:,. V.e,e q V-.C.Y� \N Ccr��SN� � 1�.♦�kJ1'�.- ��„w CZ��:
Subdivision Name Lot No. Sec. or Block No.
Lot Size --'�T House -aMobile Home_ Business: Speculation
No. Bedrooms No.-Baths, No. in Family
Garbage Disposal., . YES 0 NO Specifications for System:
Auto Dish Washer '--YES Z' NO p "` � ► i ii=
UG
Auto Wash Machine YES g2e- NO
Type Water Supply
l00 Zvi -�
".*This permit void if sewage system described be)ow is not installed within 36'months from date of issue.
.
100
1
/ J
Imp�oJements permit by
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*Contact a rearesentative of the Davie County" -Health Department final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of Eo Vp56tio .-TelephoneyN er:� 4=634=5985. -
Final Installation Diagram: System Installed by =
..�aa.
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
satisfactorilyfor any given period of time.