P5709 Farmington Rd 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 NCA' 10A .1934-.1 68) Permit Number
Name ��9//;s �y r .� �% �Date ����. N2... .5 Q J
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _1e� Business Speculation
No. Bedrooms '' No. Baths No. in Family
-�—
Garbage Disposal YES [] NO fl Specifications for System:
Auto Dish Washer YES NO 0
Auto Wash Machine YES NO C] 4,('3411,7
Type Water Supply
"This permit Void if sewage system described below is not installed within 36-months from d to of issue.
Improvements permit'by Z�I
'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 L20,2d4
V
Certificate of Completion Date i
'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.
�::�44: x,. -, _:.:.+-,,:ri„r..Ww.:,..--a,. - re.. .5*5-:i`, .,. t-...s e.l..F,.ti.i �. t ...,. .. --vis .•"ti.:-:e .. ..-. - . ,..-.-.. - ..a r: ..�.F :�;
DAVIE COUNTY` HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AN[ -CERTIFICATE OF COMPLETION .
*,NOTE-!� sued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
r _ Sewa`ge/Treatment and Disposal Rules (10 NCAC 1pA .1934-.1,968) Permit Number
-Name - %�'y //i91, _r ��'T ' / c N J109
Date `
Locations; �, ✓ �- i�� ��,; ✓// T1 �-�� Ir /:':{i��i �� a r ���
v F
Subdivision Name Lot.No. Sec. or Block No.
Lot Size House Mobile Home _ 1/ Business Speculation
No. Bedrooms No..Baths Z No. in Family
Garbage Disposal YES ❑ NO 0— Specifications for System`.
Auto Dish Washer YES NO I]
Auto Wash Machine YES NO ❑ X4, (� �
Type Water Supply
*This permit Void if sewage system described below is not installed within onths fromate of issue.
<, ,
Improvements permit byZZ
_
*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 % .14
lc
Certificate of Completion Date
*The signing of,this certificate shall indicate thaf 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.