256 Gordon Dr (2) 0
DAVIE COUNTY HEALTH DEPARTMENT.
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 1a;3�
*NOTE:'Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems(� \ Permit Number
Name dry v \ Py L+\ Date -1C, - )o - 5 No
6528
Location ` T
A CNN,
Subdivision Name I Lot No.
Lot Size House V Mobile Home _ Business Speculation
No. Bedrooms .NoyBaths No. in'Family -
Garbage Disposal YES p NO Specifications;, dor System: ox
Auto Dish Washer .YES E3' ,,NO [
Auto Wash Ma.hine YES`[3' N0 ❑ O v X';y X c
Type Water Supply
*This permit Void if sewage system described below isnot installed within 5 years from date of issue.
This permit is subject to revocation if site plans or ffie)ntended use change.
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Improvements permit byQ,- , ,
*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 SQ't' � T+
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wCe ific to Completion ` Date
*The signing of this certificate shall indicate that a system described above has been installed in compliance with
the standards set forth in the above regulatiop;Fbut shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of,time.
0
i DAVIE COUNTY HEALTH DEPARTMENT. C�`"�
' IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION0' 0
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