421 Hillcrest Dr ' DAVIE COUNTY HEALTH DEPARTMENT
D 1 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage XSstems Permit Number
Name �/ �° a ,?'%fi'!�✓ Date /G .S~ �/� ND 6183
Location /s_ " W �/' �.gk'� /�}ny y jA/' ��i�F/ -1iA"" —
.Lf' ✓ A Vr ar✓.f� o.: i/1 iDn✓t ON
Subdivision Name Lot No. Sec. or Block No.
Lot Size_Pha House 1--'� Mobile Home _ Business Speculation
No. Bedrooms No. Baths __1_L No. in Family` --p _
Garbage Disposal YES ❑ NO p-" Specifications for System:
Auto Dish Washer YES I NO ❑
Auto Wash Machine YES NO ❑ ��(,,�'3 X�� C
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.
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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: System Installed by �-��
0 W
Certificate of Completion Date _l`9
"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 Article If of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
r Name / r/f' rr�� - �'-3 G '`/fl�✓ Date �•' ^�j" `/�' N2 6163
Location /Vr '— �/ - ` %-' F �f'f �%i✓ ,%f1/ tfr f / r%f�l �;>a� —_
Subdivision Name Lot No. Sec. or Block No.
Lot Size lr House Mobile Home — Business -- Speculation
t
No. Bedrooms No. Baths No. in FamilV---f —
Garbage Disposal YES ❑ NO 2-'' Specifications for System: .
Auto Dish Washer YES NO ❑
Auto Wash Machine YES NO ❑ Q�1,''�X !� ^ a '°
Type Water Supply c> _
*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.
0,4P
Improvements permit by ���'_ Ji
*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 byr
1
v k Q w
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 arty given period of time.