1935 Junction Rd S t
DAVIE COUNTY HEALTH DEPARTMENT vi -
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 NNCAC 10A .1934-.1968) J Permit Number
Name
Location .�,/S- � r ,; = � i� —�,� ✓��r/� Jam,'-- .�/.�' �' 4,4 'c
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family `S7 _
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO ,� . _ ( I/
Auto Wash Machine YES ,❑ NO � / tl�c�c?
Type Water Supply _—
"This permit Void if sewage system described below isnot installed within 36 months from date of issue.
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
V
Certificate of Completion - Date b _
'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.
A DAVIE COUNTY HEALTH DEPARTMENT
3' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
1
'NOTE: Issued'in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatmeerit and Disposal Rules (10 NCAC 10A,.1934-.1968) Permit Number
Name /�/ /%-;�S --. ✓,7��.f�f/���{3ate ,!%4�ii�
J
Location /%','S -. �✓ .�%% 1;'!: :r ,�/ �: ,`/�. �� /%t � ^J, '�.
Subdivision Name Lot No. Sec. or Block No.
Lotl Size House / Mobile Home _ Business Speculation
rr
No. Bedrooms No. Baths _�_ No. in Family a� _
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES ❑ NO
Type Water Supply
"This permit Void if sewage system described below is riot installed wi hin 36 months from date of issue.
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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
1
._
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r
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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INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT C��egg 1,f5 S (Ifftorg
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0---< �S PHONE NUMBER d r
NAME �n 344
ADDRESS "t' I � / SUBDIVISION NAME
SUBDIVISION LOT # ,1
RECTIONS TO SITE C�� / d f W r CL74 J
�tdus� ail Cadern st
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER 2 Gr
r
SPECIFY PROBLEMS THAT ARE OCCURRING ard
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DATE REQUESTED �' INFORMATION TAKEN BY �