137 Baltimore Rd . �:''31""''fpe ttt#'c'r 9°a.y7��uta`ft••.''Y'f �tN'3'x" ,i. ,+{+ nk Y - „_
� �' �,�"�k "�� .rt aw�.r-}�§" .rs•r i'�•i.,s,r,•Y� '.'�'�,;, r ,. ���s
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND 9ERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of /"/
ani ary Se age Systems �D �' Permit Number
Name - ®S �s N2 7 5 3
Location -__J .7,-0 - /`f`��
Subdivision Name Lot No. Sec. or Block No.
Lot Size Z House Mobile Home Business -- Industry
No. Bed No. Baths — — No. in Family _ Public Assembly Other,
Garbage Disposal YES p NO Specifications for System: f
Auto Dish Washer YES E NO
Auto Wash Ma,hine YES 0' 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.
------------
Improvements permit by L
—�
*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
i'
O
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 regplation, 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
'�N y IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
a " *NOTpf-Issued in Compliance With/Article I I of h
- -Spnitary Sewage Systems = Permit Number
Name � i�ia;� �/Plys�.a� ;/,°�i`sr !r/ �'1 t � �a�'' N27534
Location ,eA,�
Subdivision Name Lot No. Sec. or Block No.
Lot Size---Z--�� House Mobile Home — Business _— Industry
No. Bedrooms No. Baths
No. in Family Public Assembly Other Af'' –
Garbage Disposal YES ❑ NO Specifications for System: '
Auto Dish Washer YES NO '"
Auto Wash Ma^hine YES p' NO
�-fes
Type Water Supply - --- X0'1•�! ? ��i
1 -his 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.
P
Improvements etmit'.bY _ A
P ,
//
*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
; �i
'i
i•
Certificate of Completion �`v � Date S
; '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.