165 Shadybrook Road Lot 12 Section CDAVIE 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 _� N2 3265
Location
U -; 511 act
Subdivision Name �`^ !�� Lot No. Z Sec. or Block No.
Lot Size House Mobile Home — Business Speculation
No. Bedrooms 3 No. Baths No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System:�14-(, K
Auto Dish Washer YESO ❑
Auto Wash Machine YES �NO .❑ C�eQ fS X
Type Water Supply
*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:
Cu4 har
G; N es
of
System Installed by 7`, I tdwk �- FeJ-t-
Certificate of Completion Date Z 7 -�Q3
'The signing of this certificate shall indicate that the system describe 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 % --Date—.
;.
Location
Subdivision Name Fi< < f 'n
Lot Size
Lot No. 12-- Sec. or Block No.
House Mobile Home — Business __ Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:(=t.+'
Auto Dish Washer YES 0 NO ❑
Auto Wash Machine YES E]' NO ❑
Type Water Supply__—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
4
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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
I '
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
Name Date
Location
Subdivision Name t �' I Lot No. f Sec. or Block No. ('
i
Lot Size House Mobile Home _ Business __ Speculation
No. Bedrooms _ No. Baths — No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System: 1 .
Auto Dish Washer YES ❑ NO ❑ t
Auto Wash Machine YES NO ❑ t i'` i t �c
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 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 } I i }
i
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.
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
-- (Septic Tank) Improvements Permit and Certificate of Completion
(Ground Absorption Sewage Disposal
System - G.S. Chapter 130 -Article
13C)
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OWNER OR CONTRACTORS{u,., it ►e r 1, j. �c� (Lr,���„ '��ra r� DATE %7
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PERMIT
Z k� t
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lr 1312
LOCATION t1
S.R.
NO.
SUBDIVISION NAME ; °€j r t, �� i LOT NO. 1 SECTION OR
BLOCK NO. C.
HOUSE IN MOBILE HOME BUSINESS
❑
House Trailer 800
Gal. 400 Sq. Ft.
N0. BEDROOMS N0. BATHROOMS
Two Bedroom House 800
Gal. 600 Sq. Ft.
GARBAGE DISPOSAL UNIT YES ❑ NO ❑
Three Bedroom House 900
Gal. 900 Sq. Ft.
AUTO. DISHWASHER YES ❑ NO ❑
Four Bedroom House 1000
Gal. 1200 Sq. Ft.
AUTO. WASH. MACHINE YES ❑ NO ❑
SITE SUITABLE YES ❑ NO ❑
SIZE OF TANK b gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public (�]
IMPROVEMENTS PERMIT BY C°?„,. ,
INSTALLED BY ► `co`
CERTIFICATE OF COMPLETION By S�n h AA
Date A/8/77
(8/16/73) *Construction must comply with
all other applicable State and
local regulations
LOT AREA
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