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- " DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems d Permit Number
Name :r�i� Date -5 �:Z� N2 7 5 7 6
Location►- •''' -; I/ J� �r � C �/S� w •,� h /rJF� f�1��_
Subdivision Name Lot No. Sec. or Block No.
Lot Size House L-' Mobile Home -------:::-business -- Industry,
� r
No. Bedrooms —,No.Baths_., Nb. in Family���t-, Public Assembly w~' Other
Garbage Disposal YES"p NO p Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Ma^hine YES`"[]' NO p'
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 usech-a—ige.,
„ 'ty� T ,� e '1 hrur•.•w'^++»m.. nr.,varw.a-,w ..x .m.....
� ....tea.
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r-
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.,
1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985.
Final Installation Diagram: System Installed by
040
t
r-
Certificate of Completion Date - /X
'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.
DAV'IE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systemsr' *41 Permit Number
Name :.>.� �4 Date , Vii' _N 7576
AT LIX
Subdivision'Name Lot No.''s�-.�.,,�__ Sec. or Block No.
Lot Size House Z-1 obile Home _ usiness ---industry
No. BedroomNo.:Baths -- . in Family ` Public Assembly Other
Bedrooms
Garbage Disposal YES p NO ❑ Specifications for System:
Auto Dish Washer YE ,NO
Auto Wash Ma thine �'ES4 N0�`p
Type Water Supply _
'This permit Void if sewage system described below isnstalled within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use c angg�
t
7,
r-
. i1
Improvements permit jy�
"Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M.,
j 1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985.
Final Installation Diagram: System Installed by
40a
r-
Certificate of Completions Date � ``iF,
'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.