610 Joe Rd 41
�► DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
"age/Treatment and Disposal Rules (10 NCAC 10A .1934-.19 8) Permit Number
Name % 1�- / Date N2 . 3523
Location L�t'�Oc✓�J �ri'S �r� /r /�/�1_'Y�� 4:��RoadC
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business -- Speculation
No. Bedrooms No. Baths __c;,2 No. in Family
Garbage Disposal YES ❑ NO [ Specifications for System:
Auto Dish Washer YES NO ❑ /��
Auto Wash Machine YES '$ NO El
Type Water. Supply
"This permit Void if sewage.system described below is not installed within 36 months from date of issue.
r
c �
Improvements permit
*Contact a representative of the Da v a County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on d of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
vU
Certificateof Completion
Date
'The signing of this certificate shall indicate that the system described abov has been installed in compliancwith
the standards set forth in the above regulation, but shall in NO way be taken a a guarantee that the system will fu ction
satisfactorily for any given period of time:
DAVIE COUNTY, HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION .
*NOTE: `Issued in-Compliance with d,;8;0' f North Carolina Chapter•130 Article •13c 1; ,• s
Sewage Treatment and Disposal-Rules (10 NCAC'10A .1934-:1968) Permit Number
Name �/ %/�) : - s �� Date NO 3523
. .
Location
Subdivision.Name. Lot No. Sec. 'or Block No.
Lot Size House I Mobile Home _ Business ' Speculation
No. Bedrooms _ No Baths _No. in.Family
Garbage Disposal YES ❑ NO �' j Specifications for System:
Auto Dish Washer YES NO
Auto Wash Machine. YES. .NO.,,E].
Type Water Supply'.
-
`This permit•Void if sewage system described-below is not installed within '36 months from date of issue.
I
Improvements permit �g
*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.
FinalInstallation Diagram: System Installed by / � 4l6
pl / .
- tl
- �' �.it • ' !.
Certificate of Completion Date' //: X_;,1/1
_ P
'The signing of this certificate shall indicate that the system described abov has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken a a guarantee that the system.will function
satisfactorily for any given period of'time.
` DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
i Y i% '�
Name Date /��- ��I�I3523
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths _ No. in Family _
Garbage Disposal YES ❑ NO E]-- Specifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Machine YES d] NO -❑
Type Water Supply __—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
_ 1
a
1
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 !%
j
i
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.