117 Becktown Rd S DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND.CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sa 'tary Sewage Systems Permit Number
�✓ Date /��
J --
Name NO
6787'787
Location C
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.2" Specifications for System: 7—
Auto
—Auto Dish Washer YES NO ❑ v
Auto Wash Ma.hine YES T NO E]
Type Water Supply (41'1' __—
*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.
mow.
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
IL
U- IP
Certificate of Completion R `/ Date 4/0—
*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.
Do
DAVIE COUNTY HEALTH DEPARTMENT S t
_.. IMPROVEMENTS PERMIT, AND .CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
ary Sage Systems Permit Number
Name '' ? �✓ /_%sr ' ��ti1 Date NO
Location 6787 .
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home -- Buness _— Speculation
No. Bedrooms No. Baths NoRn Family —
Garbage}Disposal YES ❑ NO 2," Specifications for :System: r.-116-
Auto
Auto Dish Washer. YES- p N ��� f/ a
Auto Wash Ma-.hineh.+ YES�.4"Ijo,:9,�s's9-2, �j�C/��/1 /-?J:. -
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.
.A
11mprovements 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: A System Installed by Z4,e
JIC E - i
t
k...
Certificate of Completion Ad !/ Date e10 A2
*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