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1518 Godbey Rd IL xF� DAVIE COUNTY HEALTH DEPARTMENT �-- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION , 'Note:Issued in Compliance with G.S. of North Carolina Chapter 130=Article 13c: r Permit Number .Name L ui,.S u 0'-. Date 7 Locati n Subdivision^Name Lot No.,. Sec. or Block.No. Lot Size House `""� Mobile Home Business = Speculation No. Bedrooms a" No. Baths. No. in Family- - Garbage.Disposal YES :❑ NO; R__ Specifications for System: �? r? Auto Dish Washer YES ❑ NO Auto Wash Machine YES F1 'NO, ❑-� '"�` " �b.1y 3` .X 1 V, �rsc�C Type. Water Supply "This permit Void if sewage system described .below isnot installed within 36 months from date of issue. l " Improvements permit by CL "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' 1. �'I. �WAe. tea- 1 '/V„ F,4rl 1 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 betaken 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 G.S. ,of North Carolina Chapter 130—Article 13c. _ Permit Number i , ZS Name ��w;,s =Ls s,r1 e.. Date - ��- f t ' ► Locatio� R,m:4) ot ► �i �... - I�,ci�,s�.�E <n. 1�C+ Subdivision Name Lot No. Sec. or Block No. �I Lot Size House ''` Mobile Home _ Business Speculation i No. Bedrooms No. Baths No. in Family Garbage Disposal YES NO Specifications for System: g' 3 `� l- �fl� ! . Auto Dish Washer YES p NO p—'; s; Auto Wash Machine YES,❑ NO ©� �� ` loo k3 Yi&' p?ocK �I Type Water Supply" WeAl -- *This permit Void if sewage system described below is not installed within 36 months from date of issue. i \.UL11 { Improvements permit by , r Contact a representative of the Davie County Health Department for final inspection of- this system between 8:30- 91:30 A.M. or 1:00-1:30-P.M. on day of completion. Telephone Number: 704-634-5985, �Final.Installation Diagram: ; • System Installed by ) ]13nW}25- I 41t Certificatf Completion �^^c _ Date !, e"oV— P The signing of this certificate shall indicate thatl the system described above has been installed in compliance with th'e 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 DEPARTMENTI ENVIRONMENTAL HEALTH SECTION ' P.O. BOX 57 i MOCKSVILLEr N.C. 27028 (704) 634-5985 STATEMENT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS NAME i.Sbn �. DATE'I ADDRESS ,V-Ic. 1 PERMIT NO. 1 EXPI AMTIO14 OF CHARGE i i AMOUNT. DUE t ,tN SANITARIAN PLEASE; REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT. *NOTICE: Evaluations) can not be completed uniil' payment is'received. Improvements Permit(s) can not be issued until payment ,is received. Int - _. 'r•