268 Bear Creek Church Rd..: .,:.._....•..s. .........�..: .r :i.r. .. _: w-.....: f. •" ',. yr ,.r.. .t.- s a F.+.s &-'. a ^-- za-tr _ -,. .. :. .... ..-.. .. _ .. /n�. .
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 (( o 7
- �. N� 5 5 'CZ \r � "�. N � � J I � _ � t �
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Sizes House Mobile Home _ Business . Speculation
No. Bedrooms 3 No, Baths 1 No. in Family _
Garbage Disposal YES Q . NO Specifications for . System: oac
Auto Dish Washer. YES 1p NO �{
Auto Wash Machine YES f NO p
Type Water Supply W ���• _
y
7
*This permit Void if sewage system described below is not installed within 36f months from date of issue.
J
Fir -
Improvements permit by x`1_1_
*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--s�-�-� U
P 0'
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30
fl d u -Pp
Certificate of Completion C- Date
koffi�AIL
*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.
(10
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
�4I 6T. E, sue n 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 5571
Location A (I
Subdivision Name - Lot No. Gen Block
Lot Size House' \'--
No. Bedrooms No. Baths No. in Family
�Garbage Disposal. YE8 NO
=� `
Auto Dish Washer ` ' YE [] NO
Auto Wash Machine -\V `
Type Water Supply
�
*This permit Void ifsewage system described beo�ianotinobs�dw�hin3��mon��ofn�m�dabaof�aue
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|m permit by
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*Contact a 'ep'e"e"""",e of the "",'° 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: 704-034-5985. ,
`
Final Installation Diagram: System Installed by
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Certificate of Completion Date ~
*The signing ofthiacerbfoatemha| indicate that the system
described above has been installed in compliance
the standards set forth in the above regu|abon, but shall in NOwoy be taken as o guarantee that the nyab*nn will function
'
satisfactorily for any given period of time. `
^
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'
.
.
�
|m permit by
^`
*Contact a 'ep'e"e"""",e of the "",'° 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: 704-034-5985. ,
`
Final Installation Diagram: System Installed by
~
,
-
-
-
�
17 6
�.
-
'
`
'
/
^ *
' ^
Certificate of Completion Date ~
*The signing ofthiacerbfoatemha| indicate that the system
described above has been installed in compliance
the standards set forth in the above regu|abon, but shall in NOwoy be taken as o guarantee that the nyab*nn will function
'
satisfactorily for any given period of time. `
^
INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT
NAME OS� o.h-A PHONE NUMBER
ADDRESS. ` l,� SUBDIVISION NAME
SUBDIVISION LOT #
DIRECTIONS TO SITE �o O 1 N "
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING��?-