P6036 Liberty Church Rd DAVIE COUNTY HEALTH DEPARTMENToiar
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage System Permit Number
Name e c-, -0 Date N2 6036
Location ov�.
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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 ❑ NOd % I '
Auto Wash Machine YES"p" NO ❑ ' "` `�. ,
Type Water Supply -p _
*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.
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Improvements permi
*Contact a representative of the Davie County Health Department for final inspection.. 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
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Certificate of Completion Date r V
` *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.
DAVIE COUNTY -HEALTH DEPARTMENT
IMPROVEMENTS PERMIT' AND CERTIFICATE OF COMPLETION a�
- *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems, J Permit Number
Name Date l r!; J ? No 6036
Location �,� r ;. f � _ �,:.,_ c�5. .�tin a. �•5 _._ � ,. L U,,� _
Subdivision Name t Lot No. Sec. or Block No.
Lot Size <t House Mobile Home _ Business Speculation
No. Bedrooms No Baths No. in Family _
Garbage Disposal YES ❑ NO [2Specifications for System:
Auto Dish Washer YES ❑ NO d 1 t ,
Auto Wash Machine YES-[fir NO ❑ P ��, �1 ty >
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.
• c"
t,
Improvements permit"by
*Contact a representative of the Davie County Health Department for final inspection 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.
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Final Installation Diagram: System Installed by4 0� 'r�
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Certificate of Completion "`��� Date �� I _ 90
*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.