150 Center Circle Lot 27L A\�4a
e
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
- _'NOTE: Issued in Compliance With Article III of G..$ Cha to 130a
Sanitary Sewage Systems �2�°—�—� Permit Numb- 0
Name y �ac�pat �� y Dateal' as -13 - 94 N2 7 8 2 a W)A-P
Subdivision Namey ' 5apt,Af got No: Sec. or Block No.
Lot Size oo u;2oo\ House Mobile HomV, Busine`ssg Industry`. Y1
No. Bedrooms3T; Noy Bkths =*-� No. in Family/' — Public Assembly Other
w, *t,t t,q
Garbage Disposal YES ptts, O �' x Specificai%ns.,for Syatem: ° `v 1
her
Auto Dish Was�r YES„❑ No' [ ' I �/ooa '�,A - Q
Auto Wash Ma:hine YE5 NO, ❑ h =sem p9�Y t,
Type Water Supply.._ C{rsa u rSlw,. - S�t�S, �ntw a00I 3 I 'V a J
'This permit Void if sewage system described' belo%d'is not installed within 5 years from date of issue.
This permit is subject Wrevocation if site plans or the intended use change.
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X i E y
Improvements permit byn
'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: `y System Installed by �-A-►3
S S11CNp W lJ
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Certificate of Completion `-�w""� Date X23 h
'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.
�` iFe 2H DAVIE COUNTY HEALTH 'DEPARTMENT
M"' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION a
TE: Issued in Compliance With Articl II oof G. . Cha to 1,30apermit Numbev� 3-y
Sanitary Sewage Systems
_ �,�o� 09
e �� 782 W A
.lame. a^5. Date x l a j 3 94 N_
Location 4 a s
Vim` �L v k S �+� F ) ( 0e,491 -
l // ,
Subdivision NameJ�'Ub�`� ,t n Sec. or Block No.
1ot-Size.p6��` House Mobile Home'`_,"_,;T� Business, Industry^
_r^.: �.
No. Bedrooms tNo: Baths No. in Family t.. — Public Assembly Other
-• Garbage Disposal YES ❑b. NO CzJ' Specifications for System:
Auto Dish Washer YES,,Q NO Q'°o.r, 4*r�Ft
Auto Wash Ma
;hine YES "b}• I�O, ❑a
.Type Water Supply
` . Sz...
'This permit Void if sewaget§ggtem described below is not installed within 5 years from date of issue.
This permit is subject to revocation if s(.te plans or the intended use change.
IJY
_ 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 4:30-6:00 P.M. on day of, completion. Telephone Number: 704-634.5985.
Final Installation Diagram: System ,Installed by
r Certificate of Completion ` Date
'Ther igning 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 hereby certify that the above septic tank has been installaccordinngto spolicatioi
Note: Make sketch of disposal system on back of sheet 'and mail"to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
DAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK
PERMIT Date
u' Z
y' r
Jwner/Occupant
_.
To:
7
-O
Address Lze-Z c rk
Address .
-ell
Building Contractor 01 le i
Address
/ C r
Cal. _ 6b Manufacturer's Name
i�8 f Address
No, of lines Width_Lin. Total length
o?€>o
ft. No, sq.
ft.6F
Type of filter maiiterial/IS
- ,_ Total tons
used
Minimum REquirements: House Trailer Tank
cap,,,,, 800
Sq. ft. line
400
Two-bedroom house
800
600
Three-bedroom house..
900
900
No one shall install a septic tank in Davie
County`without
a permit from
the Health Offic
or his agent.
Date of Final Approval
Signed: �%
(L�•l�J?itE'��
�_
`S
itarian
I hereby certify that the above septic tank has been installaccordinngto spolicatioi
Note: Make sketch of disposal system on back of sheet 'and mail"to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
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