460 Pine Ridge Rd 1164
DAVIE COUNTY HEALTH DEPARTMENTS o�,
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name �_ll a.�-'C N fi� �,� Date ' _� _ N� 5�'4 2
Location �� �-`\ �� P —
Subdivision Name
d� L o Sec. or Block No.
Lot Size ot''_L _-House ilvlobile Home _ Business Speculation
No. Bedrooms `No. Baths No. in Family
Garbage Disposal YES ❑ NO Cd', Specifications,,for System:
Auto Dish Washer YES pNO ❑ -
0
Auto Wash Machine YES NO ❑ j -21
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.
IS
Improvements permit
*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
�s
s�
Certificate of Completion Date
"The signing of this certificate shall indicate that the system descri d 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.
DAVIE COUNTY{HEALTH DEPARTMENT �-
°'= ,- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chlpter 130a
Sanitary Sewage Systems Permit Number
� _ 0
Name l 's-�"` . _) �, C� .�,� _Date N2 5842
Location
Subdivision Name \ Lot o, Sec. or Block No.
Lot Size a G�'' �� `� House .Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family " —
Garbage Disposal YES ❑�,NO E3-, Specifications-for' System:
Auto Dish Washer YES p NO ❑ ;", �) -
Auto Wash Machine YES NO ❑ 0 `l�1
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.
;w
r
Improvements permit by f..
*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 Diagdam: System Installed by I tA^4
�s
9
Certificate of Completion � aAb Date
"The signing of this certificate shall indicate that the system describ d 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 INFORMATION FOR SEPTIC-SYSTEM REPAIR PERMIT -�
NAME `P�-'C �A`N"N"zl-\ PHONE NUMBER
ADDRESS(' l ��� SUBDIVISION NAME
Le
k
SUBDIV ON L O�
DIRECTIONS TO SITE
r
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED 2, 3 D INFORMATION TAKEN BY