484, 490, or 510 Gun Club Rd DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems J Permit Number
Name .��s� it lr'r(/..� %��/ Date �71�-� / l� N2 5940
Location /%i /N r`'i�a/��" c�/✓ dl�� .�;.i�r. 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 p- Specifications- for System:
Auto Dish Washer YES NO ❑
Auto Wash Machine YES NO ❑ �Q� Y3kr:2/��
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.
x,11 I�r L'
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
S
S��"'ZLa�Z-
Certificate of Completion _ Date l�`
"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.
0. DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
�*NO`fE:Issued in Compliance With Article II of G.S.Chapter 130a
'Sanitary Sewage Systems �7` / Permit Number
Name ,���/ Date ��'= � f� ' IVo 59,10
Location �� v–` // �;rf iii✓ ��i.c>li,�' f,r� .�Tt !7�. �, (,,.• !.' :c
7� u
Subdivision Name `�� Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business -- Speculation
No. Bedrooms - No...Baths 1 No. in Family
Garbage Disposal,' YE_S-p NO p- Specifications for System:
AutoPish Washer .. YES NO ❑
Auto Wash Machine YES 'NO ❑ /ems
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.
On
Improvements permit by ZZ
'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
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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. `