P6244 Hwy 801N - Davie EMS s DAVIE COUNTY HEALTH DEPARTMENT
11 M_
PROMEMENTS PERMIT AND CERTIFICATE OF COMPLETION
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� C(t NOTE:Issued in Compliance With Article 1-1 of G.S.Chapter 130a `t i- qa
Sanitary Sewage Systems_ ` Permit Number
Name v -2 Date - �y ciI N2 6244
Locations
Subdivision Name Lot Nn. ec. or Block No.
Lot Size House Mobile Home _ Business ✓ Speculation
No. Bedrooms -No. Baths No. in Family - _
Garbage Disposal YES ❑ NO [g' Specifications for System:
Auto Dish Washer YES ❑ NO'p
Auto Wash Machine YES ❑ NO X ) U PSC
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 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 C Q Q
Certificate of
i ' ate Completion f _>; Date /
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"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 v �
, � PR(�1LEMyE�NTS PERMIT AND CERTIFICATE OF COMPLETION , � 0 a
���NbfE:,'Issued in Compliance With Article I I of G.S.Chapter 130a 9 9`[- A' Sanitary Sewage Systems Permit Number
Name \� �; ,. 10 Jy C- �'C — Date - l 9 / N2 6244
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Location
Subdivision Name Lot No. ---Sec. or Block No.
Lot Size House Mobile Home__ Business —� Speculation
No. Bedrooms No.'Baths No. in Family
Z
Garbage Disposal YES 0 NO '[ly Specifications for System:
Auto Dish Washer YES 0 NO [a
Auto Wash Machine YES 0 NO [2-/ X U Q
Type Water SupplyThis 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.
,`.
o'
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
Sa
Certificate of Completion EJB 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.