487 Ben Anderson Rd s...� � � ... � 1� l q1 r.x:l Yi-Y� .:Ca I�• C.'s 'E}a:'S , 'l�r r.. .
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
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S wage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968 Permit Number
Name� 1-e / /'�^ 1` ILI "� Date ��-.may' N2 L}/n� U
i
Location
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 p NO p— Specifications for System:
Auto Dish Washer YES p NO O
Auto Wash Machine YES (h NO p
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 /r
*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
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Certificate of Completion �- Date 1A—�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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DAVIEOUNTY HEALTH DEPARTMENT
f IMPROVEMENTS P MIT AND CERTIFICATE OF COMPLETION
*NOTE: Is`sued=in Comp TiaCarofna, Chapter 130 Article 13c
wage Treatment and Disposal Rules (10 NCA&1 OA .193 —.Permit_Number
Name �' `� Date NO
Location /t "eZ , �' J -ti 1,J"-S,
Subdivision Name Lot No. Sec. or Block No.
Lot Size Pouse Mobile Home._1-�' Business Speculation
No. Bedrooms �... No. Baths No. in.Family
Garbage Disposal YES O NO 9— Specifications for System:
Auto Dish Washer YES NO p
>. � 1
Auto Wash Machine YES $ NO C]
Type Water.Supply _
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
.) o6.
}
�.., Improvements':permit by.:
*Contact a representative of the Davie County Health Department.for final inspection`bf 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 ��- �. ,•
(JO ' t-5
t
r
Certificate of Completion` C �= 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.