P4786 Madison Rd- -M'. _• .. b'. .I -tee �.., �,.-l.e...i y.. M.'..xv'!./'. r. v• :i 1:. ''.5 t+.. .4ar ... ..,._a '"-..r:.. x:�, - ... . .. -
DAVIE COUNTY HEALTH DEPARTMENT P 3 D
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-���• fic---f — Date
Rr-z�-k7
Location -t-_ ^,.-A. S .,-a c '9 u t -.-c- iz.e •1,. 1, :� �. < ,1 .n;, —
6. 1, f---1 - ~i .. k' --r ,- r
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms -; _ No. Baths No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ NO ❑
Type Water Supply r• t-,, ,'� ► --- e.. + -1, f <. 4 �)„�c
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
J>
tit,
-.-�-
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.
i
Improvements permit by
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:
1 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.
�
-,
-DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: -Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
t-.. Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit
Number
Names— i Date
Location _1
_
Subdivision Name Lot No. Sec. or Block No.
Lot Size :House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family--
amily _Garbage
GarbageDisposal YES ❑ NO ❑
Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine . YES ❑ NO ❑
Type Water Supply -
< .,-; -t
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
t
i
Improvements permit by
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:
1 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.
1
In
v alaie (gauntU P" Calth P epartment
anb Paw PeMIth �Senq
P. O. BOX 665
c4lorhoville, North Carolina 27028
CONNIE L. STAFFORD, BA, MPH
Health Director
June 9, 1987
Benny Atchley
Rt. 1, Box 25-7
Mocksville, NC 27028
Dear Mr. Atchley:
A representative from this office inspected the repair to your
system on June 3, 1987. At this time the system was operating properly.
If you have any questions, please feel free to contact this office.
Sincerely,
Charlie Little, R.S.
Environmental Health
CL/wd
TELEPHONE
(704) 634-5985
(704) 634.5881