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✓) * DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:I-pstLgAjn.CnmpaianceWithAdicle 11 of G.S.Chapter 130a - -- --- � - --
j�anitary Sewage,Systems �1 1� Add Permit Number
_Name e46bi t �c ref! Date –7 ?o2 NO 6862
Location —
pry /c'° —
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business -- Speculation
No.,Bedrooms - .No. Baths a No. in Family
Garbage Disposal YES ❑ NO d, dSpecifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Ma shine YES g NO `❑
Type Water Supply ---
.*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit subject to revocation if site plans or the intended use change.
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 704-634-515.
Final Installation Diagram: System Installed by .
_ J .
Certificate of CompletionDate 1
'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.
<w._� �dol t,' ,.i.�r+ •`.0-r' ..,Ca '�:;, �.'i�' `, ..,. -r -. •, ,r" -:L ti,. .t,,,' --_ - � :- .. -, . c. t--
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION -
.-NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a ,..... ,.... . .. ._.._.__ '
R SanitarySewage�$ystems , Permit Number
- _ P
3;� / .e •�. Date N_ 6862
Location /'S'c`i� – {�1f1:� .�f'er ✓r
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _T Business _— Speculation
No. Bedrooms No. Baths _CP= — No. in Family
Garbage Disposal YES ❑ NO Qi Specifications for System:
Auto Dish Washer YES NO ❑ 1. i� _
Auto Wash Ma:hive YES NO ❑ p �+� �1/ ���
Type Water Supply
'This 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.
A I Cl?
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 —� ' k1 U " ��(Le
. a'
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.