133 Raintree Road Lot 5DAVIE COUNTY HEALTH DEPARTMENT Q, �Jcl
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage SysteLns Permit Number
Name V 10N 'J Date 9- N27432
Location
SVE
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business Industry_
No. Bedrooms--" No. Baths No. in Family Public Assembly Other
Garbage Disposals - YES 11 No El
Specifications for System:,,.
Auto Dish Washer YES E] NO E],
Auto Wash Ma,3hine YES V�,1,NO E]'
Type Water Supply c)
*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.
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.
,
I Final Installation Diagram: -
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System Installed by
40
(4
J 100/
Ce : rtifidate of Co I mpletion Date V:)"' Ll
*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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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*N OTE: Issued in Compliance With Article I I of G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
V \J
Name Date 17, N27432
Location \J
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Industry_
No. Bedrooms --.No. Baths No. in Family Public AssemblyOther
Garbage Disposal YES [] NO E] Specifications for System:
Auto Dish Washer YES E] NO ❑
Auto Wash Ma^hine YES NO E]
Type Water Supply V
*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.
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:
-T
x
System Installed by N-
H 1-1
o0l
21 0ol 97
LA
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 G.S. of North CarolinaChapter 130—Article 13c.
�/ Permit Number
Name J1lt �ti,+��. �w �� C.�'� I� Date �� s� % +M' 2-127
Location
C L`
Subdivision -Name �1�C ri-' ' � +>���x tom Lot No, _ Sec. or Block No.
Lot Size '` S �` / ��� House Mobile Home-_ Business Speculation
No. Bedrooms No. Baths 'No. in Family
Garbage Disposal YES. NO ❑ 1 Specifications for System
Auto Dish Washer YES E, 0
Auto Wash Machine YES NO 0 f i
Y �! I
Type
Water Supply
le,� ` �,v E'
;.. *0is permit Void if sewage system described below is not., installed withinf 36 months from date of issue.
11 t�" . II
rl p
T i -
!1 I
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Improvements permit by
*Contact a representative of the. Davie County. HealthDepartment 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
Certificate of Completionow. 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. It
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
NAME J
ADDRESS
Z44 4
Explanation of charge
DATE ISSUED 7
PERMIT NO.
AD40UNT DUE ) SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT