P6603 Hwy 601S f -
r DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION s
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a '
Sanitary�Tage Systems p Permit Number
Name__ � S2? Date I - I I 1 NO �,
Location �. 0�1 C'6 o �v y � � � ` � �
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business _. Speculation
No. Bedrooms .No.,Baths No. in Family
Garbage Disposal r --YES p 1 0, Specifications ford S stem:
Auto Dish Washer YES ❑ ., NO p� � ' : '
Auto Wash Ma shine YES E NO,[0
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.
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Improvements permit
*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. q�
Final Installation Diagram: System Installed by
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90 �o
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Certificate of Completion `-_��j, Date _ 7
*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 I_
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
*NOTEAssued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name y_ �_,�r Date �"1 Q
Location ,
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business � Speculation
No. Bedrooms .No. Baths No. in Family _
p
Garbage Disposal = YES.. [I No 0 »;
Specifications for. System:
Auto Dish Washer YES ❑ NO 01
Auto Wash Ma.hine 'YES ❑ NO [, oo �,�1 �i
\
Type Water Supply f C U � = --- '' _ x
*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.
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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
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rtti
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.