P5857 Yadkin Valley Rd DAVIE COUNTY HEALTH .DEPARTMENT
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IMPROVEMENTS PERMIT WAND CERTIFICATE OF'COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name �f��,/%,'9i .� �9 P� .moi/� Date N2 5857
Location >/� :>��✓ �/, r - , %���. ��- ,�, /rte" r i -/�T ,
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Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home L--r Business _- Speculation
No. Bedrooms — No. Baths No. in Family _
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 not installed within 5 years from date of issue.
This permit is subject to revocation if s�ns-or-thein ended use change.
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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 b
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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.
' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name �,�� �i � �t> l s`1/-"_ Date
N'.f,� 5857
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Location r:' r / I�� - : �i'.=- ,rr r /F ter'r-'/�~ 57
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home L--- Business Speculation
No. Bedrooms No. Baths No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES Q NO V/
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 sins-orthlin ended use change.
r
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.
47
Final Installation Diagram: System Installed by(-
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Certificate of Completion --z`�%k 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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g- INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT vop
f NAME VtP K PHONE NUMBER 9`�4 4
ADDRESS 9 SUBDIVISION NAME
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SUBDIVISION LOT M
DIRECTIONS TO SITE • k L W e- -
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRINGr���
DATE REQUESTED / -�� -�� INFO TION TAKEN BY y���