541 Davie Academy Rd .x; "� DAVIE COUNTY HEALTH DEPARTMENT
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IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION }
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
.Sewage Treatment and spsal Rules (10 NCAC 10A .1934-.1968 Permit Number
Name � v4d �1� -�7� ���.0-�-L Date N2 5268
Location �7,�.1 �f�•-- Sj �r�/S�/% �� , �ly- �/ ��
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 .0 NO Q— Specifications for System:
Auto Dish Washer .YES NO ❑ ,G.� � r����/�f�
Auto Wash Machine YES j NO p tv
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit by
*Contact a representative of the Davie County Health epartment 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. J
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 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 94
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
' *.NbT :' Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment anc spsal Rules (10 NCAC 10A .1934cy.1968/): ,-Permit' Number
` Name �. �� Fir --�7�� ./r:,� ,•l' Date 0 C' tea
Locationy / %C /,� d-�✓ �y ', _
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 C❑ NO 12—� Specifications for System:
Auto Dish Washer YES NO p
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.
t
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Improvements permit by
*Contact a representative of the Davie County Health bepartment 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 '
Y
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A
`.
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.
P