3931 Hwy 64E 1 . � -�, ) ,*,4,r'y;` r w.- .a..:1.... {�I/v`�• ..- r- a: o}r - ., --' r5 •` t'
DAVIE COUNTY HEALTH DEPAR. MENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
i ew ystems q
Permit Number
Name „ t/��S,j%i/',i,. T' NO 71
Date ►-
LocationGf,_J,,,-//`Si � � ��� ��,t/• /�� �. % /� fl d v�s�r� ,
Zey
Subdivision N e Lot No. Sec. or Block No.
Lot Size House Mobile Home _T Business Speculation
No. Bedrooms .No. Baths No. in Family _
Garbage Disposal YES ❑ NO 6 S fy� ,fir Syp�e
Auto Dish Washer YES [� NO ❑ �V 'J
Auto Wash Ma:hive YES NO ❑
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 by --
*Contact a representative of the Davie Cdunty 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_
�o' e A-) , a
c le.,Ve,d�-
\ Certificate of Completion Date
e signing of this certificate shall indicate that the system described above has been installed in compliance with
\
standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
factorily for any given period of time.