530 Liberty Church Rd (2) DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
911
*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
Name ��� �_ =��i p -_ Date -2 - 'f 9 NO t:�X 3 2
Location
Subdivisiob Name iJ Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No. Bedrooms No. BathsNo. in Family _
Garbage Disposal YES p NO p' Specifications for System: --�
Auto Dish Washer ' ' YES p ' NO E]'
Auto Wash Machine YES NO p
Type Water Supply "`•-� _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
1
'Improvements permit by
*Contact a represe ative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1: P.M. on day of completion. Telephone Number: 704-634-5985.
Final I tallation is$ram: System Installed by
l3s
ZS-
Certificate of Completion Date `� 3
*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.
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DAVIE COUNTY HEALTH DEPARTMENT
�r IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
1*N(7TE 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
`Name `��'�� �_ ;a r' S Date N2 5 4 J s
Location
pio Ft
Subdivision Name Lot No. Sec. or Block No.
Lot Size L House Mobile Home'— Business Speculation
No. Bedrooms No. Baths No: in Family _
Garbage Disposal, YES ❑ NO ❑' Specifications for System:
Auto Dish Washer: YES ❑ NO
Auto Wash Machine YES NO ❑ ��; J ' , `
Type Water Supply _
*This permit Void if sewage system described below isnot installed within 36 months from date of issue.
n
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 1:00-1.3 P.M. on day of completion. Telephone Number: 704-634-5985.
FinalIrk tallation`t7iag am: System Installed by ��
'e.
,s ----��
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.