P7552 Jack Booe Rd +YrJ S t 'i. �{-ti+ w tw.r'1.. »xr •+�...- -�1' '� .:xa .. .�
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DAVIE COUNTY HEALTH DEPARTMENT. .
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
S nitary Sewa e Sys eMpi 4ve- Permit Number
Name F <` . Date NO
7552
P �sc t J /fes // r/ Oi✓
Location � � � �
A/_ - --
Subdivision Name Lot No. Sec. or Block No.
Lot Size House 1--o" Mobile Home —T Business -- Industry
No. Bedrooms —.No. Baths No. in Family c;2 — Public Assembly Other
Garbage Disposal YES ❑ NO 2o-' Specifications for System:
Auto Dish Washer YES NO ❑ // p
Auto Wash Ma.pine YES NO ❑ �����X/� �r X✓ %0
Type Water Supply — __—
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
wf This permit is subject to revocation if site plans or the intended use change.
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Improvements permit by — 1GL
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985.
Final Installation Diagram: System Installed by
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:,
DAV'IE COUNTY HEALTH DEPARTMENT
M IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
i` NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
S nitary Sewa a Sys em �,� Permit Number
Namerriga /QI'i�'�#/� e09 Date =5 N2 7 5 2
Location
le`f 7/
Subdivision Name Lot No. Sec. or Block No.
Lot Size -- House Mobile Home _— Business _— Industry
No. Bedrooms — —.No. Baths No. in Family�2 Public Assembly Other
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Ma;pine YES NO ❑ �� ��'�
Type Water Supply
y
'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.
Pay�
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t
%* M.
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., j
1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985.
Final Installation Diagram: System Installed by
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.".._"