172 Oakdale Circle Lot 11 R J
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
•NOTEHssued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems L_ `f Permit Number
Name t V ��'('�c�A N -- Date J - � - N2 8034
Location
VA
Subdivision Name �� ��� ��" Lot No. Sec. or Block No.
Lot Size House V Mobile Home —L--- Business _— Industry
No. Bedrooms �� _. 1
_ No. Baths —3—_ No. in Family ` — Public Assembly Other
Garbage Disposal YES ❑ NO 0� Specifications for System: - • BDX
Auto Dish Washer YES [R,' NO,❑
Auto Wash Ma^hine YES gK NO [] l �` x' 3 X
Type Water Supply '� oy ��� `�
'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
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM, \x _
r
IQ
D
-------------
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.,
1:00-1:30 P.M. or 4:30-5:00 P.M.on day of completion.Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
b 6 v-S Q
g
o, 4"a
fid' ��tie
S C)
)001
a
Certificate of Completion ` - Date s__N _
'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.
i'
-
_ .Y ✓ `X C
DAVIE COUNTY HEALTH DEPARTMENT ''''' g
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
,d *NOTE issued in Compliance With Article 11 of G.S.Chapter 130a t
Sanitary,Sewage Systems Permit Number
Name..' \ ---- Date _ N2 8034
Location l- ' ` F a r (`,;;.. . � . . ,.ti ,`.\ �'1 • ' r' ( i
Subdivision Name = Lot No. Sec. or Block No.
Lot Size rl — House U" Mobile Home ---_ Business -- Industry
No. Bedrooms _.No. Baths No. in Family Lf — Public Assembly Other
Garbage Disposal YES ❑ NO M/ Specification`s for System: -3
Auto Dish Washer YES CR' NO ❑
Auto Wash Ma,:hine YES Cgl` NO ❑ u
Type Water Supply x
*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
r,
`ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMI /LAYOUT BEFORE INSTALLING THIS
SYSTEM,
N
z
Off`` SNA
c „
,0
e f
30 � i l'
lrproyements permit 'by �` I
*Contact a representative of the Davie County Health Departm¢lnt for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M. or 4:30-5:00 P.M.on day of completion.Telephone.Number:704-634.5985.1
Final Installation Diagram: ystem Installed by
'
�o
'_07 ��,'V?
ra O t
/f_ r 4
Certificate of Completion ` _ Date 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.
V ki
r.'
C /, , • !� DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) /
NAME �e �� a--r- PHONE NUMBER 9'?f_1:R U
ADDRESS f— Cr. SUBDIVISION NAME e. / 4 S•
A0('L V , /V d- A /OA X LOT #
DIRECTIONS TO SITE �a�-s- ��/' Dc�� l �J'. �-�- c�►�
DATE SYSTEM INSTALLED Q NAME SYSTEM INSTALLED UNDER � e ?
TYPE FACILITY OV NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED
TYPE WATER SUPPLY 6W)t SPECIFY PROBLEM OCCURRING ads �h �eim
DATE REQUESTED " INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge,and that I understa d I am responsible for all charges incurred from this application.
SIGNATURE OF OWI4ER OR AUTHORIZED AGENT
Rev.1193