P4837 Rainbow Rd r�+► DAVIE COUNTY HEALTH DEPARTMENT * �.
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 NCAC 10A .1934-.1968) _ Permit Number
Name �' .� �.�- ;�, � � Dated Is"
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Location ��' ,�) cs'� �� N e h 1'J r�
Subdivision Name Lot No. Sec. or Block No.
Lot Size
--; House � `Mobile Home — Business Speculation
No. Bedrooms VNO 'No. Baths No. in Family
Garbage Disposal YES ❑ NO' h
Specifications for System:
Auto Dish Washer YES Q NO ❑
Auto Wash Machine YES p-"NO ❑
Type Water Supply 0 0
*This permit Void if sewage system described below is not installed within 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
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tY! +Q
Certificate of ompletion _� Date
*The signing of this certificate shall indicate that the ystem described above has been installed in compliance with
the standards set forth in the above regulation, but sh II in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
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DAVIE COUNTY HEALTH DEPARTMENT
"IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
- f. _ x',30
. :;NOTE! Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name— T �C _ Date, " l., �( r ,. , 0 w
�._„ �.
Location` �� F- "l1 ,► r t,, c, . . `� ��'
Subdivision Name Lot No. Sec. or-Block No.
Lot Size��'�^ House Mobile Home — Busin'e's's'
T!'> Speculation
No. Bedrooms r--T--No. Baths No. in Family
Garbage Disposal YES ❑ NO Specifications for System:
i
Auto Dish Washer YESNO ❑
Auto WasH,Machine YES �' NO E]
Type Water Supply o
*This permit Void if sewage system described below is not installed within 36 months'from,date of issue.
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T
`7
ti
j
Improvements permit by
ti
*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
7-J
1
Y
Certificate of ompletion Date
*The signing of this certificate shall indicate that the ystem described above has been installed in compliance with
the standards set forth in the above regulation, but sh II in NO way be taken as a guarantee that the system will function.
satisfactorily for any given period of time.
INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
n �O ZE �d,S� PHONE NUMBER
ADDRESS P(�, ,�. SUBDIVISION NAME
C /r
SUBDIVISION LOT #
DIRECTIONS TO SITE 7�{ :2:L � Q71 lb -/0' Aloe 01
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I'le arch
DATE SEPTIC SYSTEM INSTALLED s Q/
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
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Ina_ a e a ��rs a� Y- - ler
DATE REQUESTED - � NFORMATION TAKEN BY `7� �