290 Fred Lanier Rd (2) "s 1
® ;610
DAVIE COUNTY HEALTH DEPARTMENT
W� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a `
Sanitary Sewage Systems Permit Number
Name /r i�i.�';� ! note, - N2 H90
Location
Subdivision Name Lot No. —_ Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
fir,
No. Bedrooms �� No. Baths= N� o. in Family
Garbage Disposal YES ❑ NO;;❑ Specifications for System:
Auto .Dish Washer YES ❑ NO;❑
Auto Wash Machine YES ❑ NO::❑ � � ' '
Type Water Supply _
*This permit Void if sewage system described below is not installed withim5 years from date of issue.
This permit is subject to revocation'if'site plans or the intended use change.
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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
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P (75
Certificate of Completion Date 9 - 9(19
"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.
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