133 Gordon Dr (2) / ....r5 ...., ,,,,.i < t tt.�.: N .j;:"cif �k��"fir` 3�Y',f.�aS �.'. ..j �. ... .,._ _ j i� _• • full ct �
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name Date �-1. � NO
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House L/ Mobile Home — Business Speculation
No. Bedrooms No. Baths _ No.,in Family
Garbage Disposal. YES ❑ NO ❑ Specifications for System:
Auto Dish Washer. YES ❑ NO ❑ f,
Auto Wash Ma^hine YES ❑ NO ❑ j�� X 3� `'
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.
�leve
Ir tm
7,1
Improvements permit by Q
*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.
L
i
Certificate of Completion Date w
'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.
XO
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
` *NOTEAssued in Compliance With Article I I of G.S.Chapter 130a
k /Sanitary Sewage Systems Permit Number
Name A19119x '2 � Date' ' O
6 ,92 3
Location _,z S �' �� ✓ ���/...; r � .-�. i ,�% i" —
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business Speculation xy
No. Bedrooms sem__.No. Baths c�2 No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer. YES ❑ NO ❑
Auto Wash Ma thine YES ❑ NO ❑ ?�",�3 ,j
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.
u C�
Af
r
rOP
Improvements permit by -- C
*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 byT'�' �'
Certificate of CoMpletion Date` `
'�7 !16 signing of this certificate sf all lindicate that the system described above has been installed in compliance with
the standards set forth in the above regulati6n,'but shall in NO way be taken as a guarantee that-the system will function a.
,'satisfactorily for any given period-of time.