3406 Hwy 158 DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with GS:of North Carolina Chapter 130 Article 13c
Sewage Treatment and Di posal Rules (10 NCAC 10A .1934-.1968) - Permit Number
Name 0 Date3850
Location
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`Sdbdivision 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 Er' Specifications, for System:
Auto Dish Washer YES NO ❑ �/
Auto Wash Machine YES NO ,❑ r,
Type Water Supply - _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
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Final Installation Diagram: System Installed by
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Certificate of Completion Date
'The signing of this certificate shall indicate that the system described above as been installed in compliance with
`d4rds set forth in the above regulation, but shall in NO way be taken as guarantee that the system will function
` for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
OTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules_(1 0.NCACA OA--.1 934-.-1968)- -Permit Number
Name 1 , r�r, /. %S' ,,� i' Datecid
Location
,t.
Subdivision Name Lot No. Sec. or Block No.
Lot Size House � Mobile Home _ Business Speculation
No. Bedrooms No. Baths _ — No. in Family 'r —
Garbage Disposal YES ❑ NO p'' Specifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Machine YES NO ❑
Type Water Supply
"This permit Void if sewage system described below is not installed within 36 months from date of)ssue. r
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t
1
I
i
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 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
7�
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I
Certificate of Completion % Date
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he signing of this certificate shall indicate that the system described above;has been installed in compliance with
hdards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
or.any given period of time: '