P7544 Farmington Rd ,3 lr .ybY` .e,Wr.»+::;;r;i'"`s >tk';-i+K'i''1'1�:`•>•a`,l�r'k.:.:��'"! ;r�+^w' :�'�`'':., 'k ,.-:i' !- r�.r..➢ a j`�r> t°" f W c t
141-1
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:I1sued in Compliance With Article II of G.S.Chaptes.130a
Sanit ry Sewage Systems ) Permit Number
Name,J� '23-1,1 V 170 r Date '�� �— N2 7 5 4 4
Location �I /'. o
2,e 47,P EP r��,� — --�
Subdivision Name Lot No. Sec. or Block No.
t
Lot Size 2-11le House Pt<. Mobile Home _T Business _— Industry
No. Bedrooms No. Baths —L� No. in Family — Public Assembly Other
Garbage Disposal YES [3 NO 2- Specifications for System:
Auto Dish Washer YESNO E]
Auto Wash Ma^hine YES U NO ❑
Type Water Supply /la
*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.
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 day of completion.Telephone Number:704-634-5985.
Final Installation Diagram: System Installed by
i
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
period
satisfactoril)?,for any given oftims --+`
a �.. ✓x O
_1 DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND ;CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapte#130a
Sanit ry Sewage Systems Permit Number
Name /. �7! / Date � � No 1 7t 544.
Location.��� i rte' �.� Y 1A 2Z 1�.. G AF
Subdivision'Name Lbt No. Sec. or Block No.
Lot Size ,� << House Mobile Home —T Business __ Industry
No. Bedrooms c.No. Baths —L No. in Family — Public Assembly Other
Garbage Disposal YES Q NO [;3e Specifications for System:
Auto Dish Washer YES � NO ❑ y
Auto Wash Ma^hine YES NO E]
Type Water...SupplY — Ab
*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.
,T �` t
El: I
F
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 day of completion.Telephone Number:704-634-5985.
P r�
Final Installation Diagram: System Installed by
{
C
" Certificate of Completion Date
",The signing of this certificate;shall indicate that th 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�guarant a that the system will function
satisfactorily;for any given,period.of time = ""