P6185 Cornatzer 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 >> Permit Number
Name `-�c�: +/Plt ,s.,�r� �� ,�i�O�',.�yl�/,/.✓//Date -0 No 6135
Location �� ,c.�> ✓��� c��_ /r` �i r/ %�,;r r �+ /% __.
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 ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ NO ❑ ��X��
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.
/J
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 -R
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Certificate of Completion C 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.
DAVIE,COUNTY 'HEALTH DEPARTMENT 7,
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NOTE tissued in Compliance With Article I I of G.S.Chapter 130a -
. Sanitary Sewage Systems Permit Number
-Name , inp +F� ..:,., i%r tai,c S� r' 'J/ ,>!`p .�'l�' / i�) N2 U� i
h
ate
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Location f('�/r�� ���✓,-� � �' �,: �--� �.- _ � _ t- /,:, ;,- r i;_ .���"
/LL/_1.� < ZJ.r
Subdivision Name Lot No._ Sec. or Block No.
Lot Size _ House Mobile.Home _ Business Speculation
No. Bedrooms - rte No. Baths No. in Family _-
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ NO ❑ t
Type Water Supply ;
*Thispermit 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;,se change.
b0'
Im p rovements permit b
'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: 704-634-59,85.
Final Installation Diagram: System Installed by
� s
A M
Yt /atl
r 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
`satisfactorily for any given period of time.