120 Duke Whitaker Rd DAVIE COUNTY HEALTH DEPARTMENT '
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems r / Permit Number
Name ', ,�, /, f7`��5/ / '/./� Date �/�� f N2 6 0 8 s d
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms— No. Baths_;�— No. in Family
Garbage Disposal YES ❑ NO p' Specifications for System:
Auto Dish Washer YES ❑ NO ❑ _ > �,
Auto Wash Machine YES ❑ NO ❑
Type Water Supply allIII __—
*This permit Void if sewage system described below)s'not i stalled within 5 years from date of issue.
This permit is subject to revocation if site plans or he inte ded use change.
r
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 by
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 betaken as a guarantee that the system will function
satisfactorily for any given period,of time.
DAVIE COUNTY HEALTH DEPARTMENTCV
• *=a_ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
C _
'NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems
r-,c / -/ Permit Number
Name si,"�F � / rVl� �:y: l� Date /�' y N2 €
Location /-�6f0 ``1, _ i1 / r'.,, is r �: tom.✓ r- �,J
Subdivision Name Lot No. Sec. or Block No.
Lot Size House �!' Mobile Home _ Business Speculation
No. Bedrooms — No. Baths — , No. in Family. _
Garbage Disposal YES ❑ NO D- Specifications for System:
Auto Dish Washer YES ❑ NO F1 r �.
Auto Wash Machine YES ❑ NO ❑ ��% .�'y'le
Type Water Supply
*This permit Void if sewage system described below 's'no stalled within 5 years from date b issue.
This permit is subject to revocation if site plans or1b e inte ded use change.
�r
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 by
41
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.