306 Livengood Rd (2) y
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DAVIE .COUNTYNEALTH .DEPARTMENT
F IMPROVEMENTS PERMIT AND CERTIFICATE OF _COMPLETION
k 'NOTE Issued is Compliance With Article II of G S Chapter 130a
c _Sanitary Sewage'Systems , mF Permit Number `
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' Name = ko� ,. ' a� cif ,,�,c�f,��`D'ate f y� - ' N�_4 � 1 :;V '�„
Location �_ _
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r T Subdivision Name. Lot No. ' Seo. or Block No,.
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z Lot Siie - — House tvlobile Home _Business _ Industry '
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No Bedrooms -- No Baths _- No in Family Public'Assembly - Other
Garbage Disposal, 'YES C] NO [.�]'
Specifications for System
Auto Dish Washer YES. NO ❑ �` <�° " V '�,•:a
Auto Wash Ma^hme YES .NO ❑
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I Type .Water Supply __, 'r jP f _ __ _ I G 0�i` ��� I
'This'permit Void if sewage system described below isnot installed within, years from date of issue. � '
This permit.is`s ,b t to revocation it site plans or.the intended use change ,� '
ATTENTIONYOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTAW NG THIS t
SYSTEM
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Improvements permit by' =y�-+'-�'�
•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 b _ � r _� t't2 ,
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Certificate of Completion _ Date �'�` � _
'The signing of tFiis`certificate shalC 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 betaken as.a guarantee that the system will!function
atisfactorily for any given period of time.
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