991 Dulin Rd 01
DAVIE COUNTY HEALTH DEPARTMENT
A
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 &!/ .%W/1/1 �r OC �` ,�����/ ' N22 F24
Location ��%��� �� "' �u .•� - 5 '� �
Subdivision Name Lot No. Sec. or Block No.
Lot Size - House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family 2_—
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES ❑ NO "Fee),
Type Water Supply _—
*This permit Void if sewage system described below is not installed within 36 month fs om-d?te of issue.
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 DiafrMrn: b System Installed by
I
}fib
r
Certificate of Completion Date*The signing of this certificate shall indicate that the system describe 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 ANQ CERTIFICATE OF COMPLETION
*NOTE: Issue in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Dis osal Rules (10 NCAC 10A .1934-.1968) Perrilik Number
NameSIJo'i���z �._�l� s r_?, G�' %�/ 1,. . ate ���� - N2 + 14
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House t� Mobile'Home _ Business Speculation
No. Bedrooms No. Baths Z No. in Family
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO l ��
Auto Wash Machine YES ❑ NO
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months
ate of issue. f
f.
I Improvements permit by
f:
*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: b System Installed by
I
i
A11101
Certificate of Completion Date `�
*The signing of this certificate shall indicate that the system describe '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. _