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j DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sew ge Treatm nt and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name 'vL� :�t�.� Date N2 5521
Location -�v�i✓ ��� /a /yv.� r' �-- �/1���� f�� //s"
U
Subdivision Name' Lot No. Sec. or Block No.
Lot Size House L Mobile Home _ Business Speculation
No. Bedrooms _No. Baths—,/ No. in Family –�
Garbage Disposal YES fl NO Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES p NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements per by 14 14 t/
*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: 7 -634-5985.
Final Installation Diagram: System Installed ty
i
t
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.
....- r:.- .^•`". �.. � .�� ._.:V ... ., c ..L :'.�'-1 y4;,yx='♦6'a.. r..'`'v-c r" _, fir;h. ..tw....-.iy j„ " - • - + ''�,
DAVIE COUNTY HEALTH DEPARTMENT
�.: IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
"ldT�E; Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c ).
Sew ge Treatmnt and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Nam_e.. Date/ 5521
Location _
G'
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 p NO Specifications for System:
Auto Dish Washer YES p NO {]
Auto Wash Machine YES p NO p �y/6)
--Type-.Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
ex..
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: 7 4-634-5985.
Final Installation Diagram: System Installed t y ��t
y
l7
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.