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P4935 Clydes Trail—.. .., ..-r.,.,,a ..�. r..y;.`a,k.'1J '.. iwT•rf„r.,:.Y'r�usa....�„s.,:,,.tr++y.i✓t••+�.v' ++. �`+.-tY°�r(,,- � J.�J....,-.....P-..-�,,...-.� �.. .�;,,,, ,r- 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 Nam ���) Q Date cl -�_-S f� gar,' Name Location v- �? ��b�y.-�,►� - 1, 1 � i - \off' C' Subdivision Name Lot No. Sec. or Block No. Lot Size House ^ Mobile Home _ Business Speculation No. Bedrooms Baths No. in Family 3 Garbage Disposal YES 0` -.NO Spec Auto Dish Washer YES ❑ NO 'ificationsKfor System: Auto Wash Machine YES` [( NO x 3 Type Water Supply �j ZI '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 �`� 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. s....-. 'r ca .«:.yrs.: ti y ;... ..,. ,, _ ,r,yr ;:.; .i+:`sv`tsir.'. p;»..'*re..;,,.F ..w, ,.. o�-. ., ,.• y„� 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 ^�, ��;c �1� `' ,C C Date I J Location Subdivision Name Lot No. Sec. or Block No. L Lot Size House Mobile Home _ Business Speculation No. BedroomsNo. Baths _�_ No. in Family 3 Garbage Disposal YES .0 NO 'M Specifications. for System: Auto Dish Washer YES ❑ NO Auto Wash Machine YES V NO 1 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: System Installed by — ji —S� `ig Certificate of Completion ~ Date 1 0� '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. •y " INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT NAME �� Q �S PHONE NUMBER ADDRESS g p SUBDIVISION NAME SUBDIVISION LOT # DIRECTIONS TO SITE �j Q 1 S - -� DATE SEPTIC SYSTEM INSTALLED V tin Q��M NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER SPECIFY PROBLEMS THAT ARE OCCURRING DATE REQUESTED �1-`�� INFORMATION TAKEN BY �