581 No Creek Rd (2) - t ' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
#NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name T �--�+-z 1 p,��W Qe�' Date - �' N2 5974
Location .
ts
Subdivision Name Lot No. Sec. or Block No.
Lot Size G House Mobile Home,_ Business Speculation
_ —�
No. Bedrooms •' No. Baths`— No. in Family
Garbage Disposal ,., YES ❑ NO"yj! '
"`A f, � � "Specificationsfor4System: p - �b
Auto Disfi'Washer�- YES NO ❑ _ �`
Auto Wash Machine YESt2� NO-
Type
O Type Water Supply.
'This permit Void if sewage system des'gibed below is not installed within 5 years from date of issue.
This permit is subject to revocationif site plans or the intended use change.
r ee
FA li I vim' a
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 bye=:i
Certificate of Completion Date �� 0
"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.
77
DAVIE 'COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name1, ar. s B � A��W@eC� Date 5 - � �� N2 5974
Location �'C- ? \3 a y 3 S t� e ��s 9
�1� l-- / � �� o� ���.�.a-� ��A`c� 1. , ���. N° ��''•�•.�- � �'w-�` ����,��`
Subdivision Name Lot No. Sec or Block No.
Lot Size House " ,(� Mobile Home,._ Business Speculation
No. Bedrooms No. Baths 1 No. in Family _
Garbage Disposal YES,❑ NO-V s Specifications ,for, System: - b
Auto QislWasher- YES ge NO ❑ t
Auto Wash Machine YES g3--' NO ❑- U 0 X 3 } a
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 I�
3Lit
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 ��
`Y
Certificate of Completion ? \ Date 2 c(0
"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.
WORKSHEET FOR SEPTIC SYSTEM REPAIR PERMIT
NAME --T,\-\-oT-,-t 1 AS -Sa�\�Q -- PHONE NUMBER
ADDRESS SUBDIVISION NAME
SUBDIVISION LOT#
DIRECTIONS TO SITE
�"K
DATE SYSTEM INSTALLED
NAME SYSTEM INSTALLED UNDER
SPECIFY PROBLEMS OCCURRING
DATE REQUESTED -- �. - INFORMATION TAKEN BY� � -