P6321 Milling Rd. ` � � �' FY:'6 l�Ft,.f; bt Cr3;'„1°# 1�"�y,rC�"�d ^C� ^.{ '�; �f..`t'y�r�'.(FR{y., i9,:} d4 I�-.1 .94~ t`y�l'�•r,vi.;1,ar •f``: . •e� ray ��':� �y}`,(. .y. ^.
;A. b DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT SAND CERTIFICATE OF COMPLETION
*NOTEAssued in Compliance With Article II of G.S.Chapter 130a ��
Sanitary Sewage Systems Permit Number
Nameo w A\-;-I Date 3 -� r - N2 6'j
- 321
Location 3 3 PA SAOy 'R-\Ly
Subdi 'sion Name Lot No, Sec. or Block No,
Lot Size House Mobile Home_ Bdsiness Speculation
No. Bedrooms No. Baths '' No. in Family —
Garbage Disposal YES ❑ NO [2,
-
Specifications for System:
Auto Dish Washer`' YES q-] NO`[y
Auto Wash Machine YES '[/ NO ❑
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.
a
J
3
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.
Fin al Installation Diagram: System Installed by
Certificate of Completion Date +� J
"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 oftime.
_f., .i�.yi t
< f /
DAVIE COUNTY HEALTH DEPARTMENT �
- IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETIONj,y 4 (7
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a St0 c�,\'� � �-
Sanitary Sewa a Systems Permit Number
_ Name Date ' _ N2 6321
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size jraC) House Mobile Home Business Speculation
No. Bedrooms No. Baths j No. in Family S _
Garbage Disposal YES ❑ NO [r Specifications for System: _ p•
Auto Dish Washer YES NO 0y
Auto Wash Ma.hine YES E]' NO ❑ ' . Cit U
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.
F-V Gd
3
Improvements permit bye
*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 WINI
!As sh0
Certificate of Completion � Date _� J 9
*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. ,
l
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME PHONE NUMBER J
ADDRESS SUBDIVISION NAME
SUBDIVISION LOT#
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED INFORMATION TAKEN . BY