177 Hickory Drive Lot 6-6A Section 3Z: 3w
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 Date 4 - Z -� - VL- D,1'; G
a
Location
Subdivision Name Lot No. Sec. or Block No
Lot Size
House
Mobile Home _ Business Speculation
No. Bedrooms
No.
Baths
No, in Family
Garbage Disposal
YES
❑ NO
❑
Specifications for System: Via•••;%
Auto Dish Washer
YES
❑ NO
❑
Auto Wash Machine
YES
❑ NO
❑
J
P% So Y 3' X 12"✓ ///
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.`��
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Improvements permit by0-_17j-
*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 t I a �2 t FksFt
Y
e
7
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 Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
r Name 5,,,. ,. \< < Date 'A- 2 n - 'eU s ° 4*7
Location
Subdivision Name 5 61, Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES 0 NO ❑ Specifications for System: P
Auto Dish Washer YES ❑ NO ❑ (Y '
Auto Wash Machine YES ❑ NO ❑ µ ({ D - I 0 y ,'
Type Water Supply < -J. r•. •-1
*This permit Void if sewage system described below is not installed within 36 months from date of issue. _
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 J " I I �0 a 17 4 C
�� {9 "\
61,
- e
A
WN% b. r
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b
Certificate of Completion — 4. �^^C— Date
The sighing 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
(Septic Tank) Improvements Permit and Certificate of Completion
c (Ground Absorp Un Sewage Disposal System - G.S. Chapter 130-ArticI 13C)
.OWNER OR CONTRACTOR JQvrleS .S7I f�N de jr.S -n DATE ENp 64
LOCATION
S.R. NO.
SUBDIVISION NAME LOT NO. ' SECTION OR BLOCK NO.
NO. BEDROOMS NO. BATHROOMS
GARBAGE DISPOSAL UNIT YES ❑ 0 C
AUTO. DISHWASHER YES ❑
AUTO. WASH. MACHINE YES M<44o ❑
SITE SUITABLE YES ❑
SIZE OF TANK c.` ��gal. .,AAA, a yr
NITRIFICATION FIELD :/ t"n_ sq. ft.
.,
DEPTH OF STONE IN LINES:
'.
WATER SUPPLY: Individual ❑ . Public
IMPROVEMENTS PERMIT BY Y
CERTIFICATE OF COMPLETION
BY—
(8/16/73) *Construction must
LOT AREA
al
House Trailer 800 Gal. 400 Sq, Ft.
Two Bedroom House rU_q Gal. 600 Sq. Ft.
Three Bedroom House { 00Ga . �: Sq. Ft.
Four Bedroom House 1000 Gal. 120 Sq Ft.
_INSTALLED BY ANA. /': C T .4
Date
ite and local r, gu ati ns '