392 Farmington Rd 2 .130
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name )Qp r/Li 1hWDIOIXDate.. S
Location "fL�zt,N�r,,� /Z i7: �s' js'iLice /�ai,sE vN .<i. 14-ri6,(- T �
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business Speculation
No. Bedrooms No. Baths No. in Family S _
Garbage Disposal YES ❑ NO ❑ Specifications for System: R6PA-12
Auto Dish Washer YES ❑ NO ❑ �Sv �
Auto Wash Machine YES ❑ NO -❑ S sTb�/E
Type Water Supply 1Aj,-(.4-
__—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
1 � I
11 le
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 byJ)/LLA4
Certificate of Completio Date
*The signing of this certificate shall indicate that the system descri ed 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.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND. CERTIFICATE OF COMPLETION
NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name 96&/Z. 11fNo�z�x Dates- Z ,� a 2 7
Location �li�Ytti,�,�ra� /Z i7 /f' �ilicr !/��st ciN X�.
Subdivision Name ` Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business Speculation
No. Bedrooms 3 — No. Baths No. in Family 3 —
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO .?
❑
Auto Wash Machine YES El NO ❑ /Sv "3 �$ ns i'ah/L
Type Water Supply __—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
i
i � r
LAN`
d
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 byj)/t-LAZD FITC
Lc��C—
N
1 FAcc.
Certificate of Completio Date / C73
*The signing of this certificate shall indicate that the system descri ed 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. -