P5655 Hwy 801SDAVIE 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 , a o S S Date =L0�9 %i� 0655
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size , Q�s`�T House Mobile Home _ Business Speculation
No. Bedrooms , No. Baths :No. in Family
Garbage Disposal YES ❑ NO ( Specifications for System:
- ?3 �c
Auto Dish Washer YES ❑ NO w
Auto Wash Machine YES NO ❑
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:
VkA.sem
r
System Installed by _rL���—
Certificate of Completion Date -7-13-
-'The
r13✓"The signing.of._this certificate shall indicate that the system desc ed above has been installed in complian -, with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system unction
satisfactorily. for any given period of time.
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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
t Number
Name S A\C 2 Date D- 16 -70 N27
Location
Subdivision Name Lot No. Sec. or Block No.
Lot. Size c House Mobile Home _ Business Speculation
No. Bedrooms_ No. Baths __ No. in Family
Garbage Disposal YES ❑ NO }' Specifications for System: D -
16
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES NO ❑ 0 p' 3 X t�
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 To-y�a--
Vis: -
V
Certificate of Completion Date -7-13— 9 L
*The signing of this certificate shall indicate that the system descr ed 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; /
INFORMATION FOR SEPTIC SYSTEM REPAIR PERMIT .;
NAME (� as AC ��% PHONE NUMBER
ADDRESS. SUBDIVISION NAME
SUBDIVISION LO
r DIRECTIONS TO SITE , s 4 p 1E: S cam. T
DATE SEPTIC SYSTEM INSTALLED ►�y�r�ra
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING