360 Dalton Rd DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:_Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
tlSewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
NameyJF�r�"P (. .�r�,r�/i'f `// Date ND `P�`�
_ _ .�
Locati
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms w i1 No. Baths No. in Familyri-1-
Garbage Disposal YES ❑ NO Specifications for S stem:
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES ❑ NO
Type Water Supply
'This permit Void if sewage system described below is not installed withinS6monthsfrom date of issue.
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Improvements permit byLL�L
"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 —rr�1Ci.f .l h
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P ��e
Certificate of Completion �! ��� Date v7
"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.