294 Liberty Church Rd DAVIE COUNTY HEALTH DEPARTMENT
- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a 5o,6-0
Sanitary Sewage Systems 12� Permit Number
/ %Date _ c6
Name G. i���� ,, N0. 5877
Locations
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation'
No. Bedrooms !'' _No. Baths ''� No. in Family--
Garbage
amily —Garbage Disposal YES ❑ NO p- Specifications for System:
Auto Dish Washer YES NO ❑ i_
Auto Wash Machine YES NO ❑ < % i � 't� �'
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\ se� hange.
l
�D
Improvements permit by
'Contact a representative of the Davie County Health =e"C ep7T? 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 Nu er: 704-634-5985.
Final Installation Diagram: Installed
/nes r
Certificate of Completion s ------ Date ,7� /�U
'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.
s ,
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE Of"COMPLETION..
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
g Sanitary Sewage Sy-stterns-+'.". Permit Number
�/, /Date 'j 0 'NO 5877
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.p' Specifications for System:
Auto Dish Washer YES NO ❑ �/
Auto Wash Machine YES NO ❑ k� �T�I
Type:Water Supplyw. /� _
*This permit Void if sewage system described below is not installe within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended se change.
u h�
Improvements permit by ` `
J
*Contact a representative of the Davie County Healthe` epZFrtm 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 Nu er: 704-634-5-`9`85.
Final Installation Diagram: -----Sys Installedl/r/ C
L=
Certificate of Completion Date A,5
*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.