P7499 Farmington Rd '
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` DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NOTE:Issued in Compliance With Art II of G.S.Chapter 130a
(Witary Sewage Systems ((.��Q Y Permit Number
Name ZZ?t_ 1 _ Date fo' Z__ N0 749' 9
Location~ � iJi/ 6�,. e
Subdivision Name Lot No. Sec. or Block No.
Lot Size C House_� Mobile Home"_� Business -- Industry
No. Bedrooms No. Baths 1 No. in Family" _ Public Assembly Other
Garbage.Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO -4
Auto Wash Ma-hine YES ❑ NO
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.
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oid
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Improvements permit by _t —
*Contact a representative of the Davie County Health Department for final inspection of.this system between 8:30-9:30 A.M.,
1:00-1:30 P.M.or 4:30-5:00 P.M.on ay of completion.Telephone Number:704-634-5985.
Final Installation Diagram: �i System Installed b
11'� •
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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 be taken as a guarantee that the system will function
satisfactorily for any given period of time.
er
"'VIE COUW'T'TY HEALTH DEPARTMENT V
r - _ IMPROVEMENTS PERMIT AND CERTIFICAfE- OF COMPLETION
.*NOTE-Issued.in Compliance With AnrJt'cl I I of G.S.,Chapter 130a
Sanitary Sewage5ystems y� �k �� Permit Number
J
Name ! �7 r - Date � �'� N0 147 9
Location
Subdivision Name Lot No Sec. or Block No.
Lot_ Size �i House ;, _ Mobile Home Business -- Industry
No. Bedrooms No. Baths No. in Family Public Assembly -Other
Garbage Disposal YES p NO Specifications for System:
Auto Dish Washer YES ❑ NO r
Auto Wash Ma.hive YES ❑ NO
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.
i
I
urn
e,l}I�
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.,
1:00-1:30 P.M.or 4:30-5:00 P.M.on ay of completion.Telephone Number:704-634-5985.
Final Installation.Diagram: j'� System Installed b
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 be taken as"a guarantee that the system will function
.. satisfactorily for any given period of time.