P5547 Baileys Chapel RdDAVIE COUNTY HgALTH 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
� ��,?�.�_Q_—�� Date " 1 % N2 6547
Name c v =� Qs
Location Y Ito a - Q o\ �y I S pA - _ C_9
Subdivision Name Lot 10. Sec. or Block No.
Lot Size %� c House Mobile Home — Business Speculation
No. Bedrooms No. Baths 1 No. in Family
Garbage Disposal YES ;p NO .lam Specifications for System:
Auto Dish Washer YES 'p NO
Auto Wash Machine YES ! NO p ,
C)
it
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
f-
Improvements permit by C�t�Ta,�
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:004:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System
N
by V�\�
N I
Certificate of Completion J Date \ " S1711
*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.
vT
DAVIE COUNTY HEAL1114 DEPARTMENT 'ice
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION-. 1 ��
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 S) �. 4--5 . Date ` f> 5 N2
11 1 fa 1 L1tJc�,
Location
y
Subdivision Name / Lot IVo. Sec. or Block No.
Lot Size _` (7 House V Mobile Home _�j. Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES p NO pi �
Specifications for System:,,s�,����
Auto Dish Washer YES p NO p.� D - o-/
Auto Wash Machine YES NO ❑ , _ ,,�
Type Water Supply `-��; _ iC' IX
YP PP Y ��
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
F
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 1:004:30 P.M. on day of completion., Telephone Number: 704-634-5985.
Final Installation' Diagram: System Installed by Q,
01,x
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P
s
\a �\Na
V J.0 nRa Y D. sst
F
Certificate of Completion C\�,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
t satisfactorily for any given period of time.
(�el�0-. (- INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT c'r
' off. NAME 11 q `JGS_ �]�,e . PHONE NUMBER _ %ly- L
v X0 ADD ESS BD l��' A/fSGJ S' SUBDIVISION NAME
�Qe/ SUBDIVISION LOT #
DIRECTIONS TO SITE If - 1'DpK (��. ��l. •. ��: /177 .44),45-4/
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1hlis C -f A Al P: 684-Y
DATE SEPTIC SYSTEM INSTALLED
.rJ
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER K-'XaLZ2,S'
SPECIFY PROBLEMS THAT ARE OCCURRING fD D f e-,�c L/%I'k c P-- '7i'll� Yt l ISS
/i'I lA/i,��-/--ri, —�, s®.� -�v.✓YAP rI —f i /P S'�7A.F' /✓� .
DATE REQUESTED INFORMATION TAKEN BY