220 Milling Rd DAVIE COUNTY HEALTH''DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION ;3 O
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name 0 Vs Date R - o - v NO 6143
Location
Subdivision Name of No. Sec. or Block No.
Lot Size �`��- ' *,&use LI/ Mobile Home — Business Speculation
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No. Bedrooms No:•Baths ;No. in Family
Garbage Disposal YES ❑ eNO
Specifications for System:
Auto Dish Washer ` YES p, NO p�t„ , foU l l
Auto Wash Machine YES aNO ❑ ' ` "f �,bd�
Type Water Supply ---
*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.
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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
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Ce ificate f Compl tion - ` �,`� 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.
^� ti DAVIE COUNTY HEALTH-- DEPARTMENT ,,, C) .T)
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION `f f; 3 O
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*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a ,
Sanitary Sewage System( Permit Number
Name �''�� r� s \ ,� hc,z Date R - o rl No H43
Location ---`• ""-� - *� � �-- - ,�
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Subdivision Name -- -- Lot No. Sec. or Block No.
Lot Size c - ' ,House Mobile Home _ Business __ Speculation
No. Bedrooms No: Baths L `No. in Family
Garbage Disposal YES ❑ NO Specifications ''for System:
Auto Dish Washer YES O` NO p" ppb'l
Auto Wash Machine YES NO ❑ ph 1 s ��.
Type Water Supply
*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.
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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 )
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Ce�,tificate f Completion - � _ Date
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*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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WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT �0 K
NAME f PHONE NUMBER
ADDRESS 'baa ��/�r7r '7 c, ' SUBDIVISION NAME
t
SUBDIVISION LOT#
DIRECTIONS TO SITE ° h h ' ` rl
fix fine
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER f�J� � t7057XE
SPECIFY PROBLEMS OCCURR G ffT��- S� d
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DA;E" REQUESTED ORMATION TAKEN BY
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• • Davie County NealtF�:De artmm
l ft Aen
and �7fome .,7�ea � y cy �.,,. •:.:;..,;.
210 HOSPITAL STREET P.O.BOX 005 f; '
MOCKSVILLE.N.C. 37.028 .}'i'► `'
PHONE:(704)034.5985 r ^'
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November .30; •1990 s
Howard Realty
s:
Attn: Connie Kowalske
330 S. Salisbury St.
Mocksville, NC 27028
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Re: Repaired Septic System'-)`
Dennis Palmer - Permit 6193
220 Milling Road
Dear Realtors
The septic system at the aforementioned property was repatred• on
September 26, 1990. This system should now function properly.
If you have any questions, please feel free to call this office.
Sincerely,
Charles E. Little, R.S. ^
Environmental Health
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Enclosure
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