1767 Hwy 601S (2) :.T,: t ..: ;, s., - r•h i.-.a " .,,,, a.rr ,p r. y.x—„'-. rC'„ ,
DAVIE::COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a'
Sanitary Sewage Systems ti Permit Number
Name r ��C �7`�l�t`,,�! .�f..�� Date _ `� / N2 641. 1
Location
Subdivision Name Lot No. Sec. or Block No.
i
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 Ma shine YES ❑ NO ❑
a
Type Water Supply
*Thi
s,permit Void if sewage system described below is not installed within 5 years from date,of issue.
This permit is subject to revocation if site plans or the intended use change.
F
r
Improvements permit b
P Y � ,Z/
*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 _ ! �'� 'A�`� -) /-�• h
1
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las
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.