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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION .; I
*NOTE: Issued in Compliance with G:S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) / Permit Number
Name � `���i ��� ,��fx �i/,��P Date
Locatio
115-e
Subdivision Name Lot No. Sec. or Block No.
Lot Size House �Mobile Home _ Business Speculation
.sl
No. Bedrooms _ No. Baths _ No. in Family
Garbage Disposal YES NO Specifications for System:
Auto Dish Washer YES NO p
Auto Wash Machine YES �] NO •Q /S�D X�X/
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 mon rom date of issue.
)vf
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
i
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.
..,. .:;. : ..,...r .,nF:.,.. :, ....a;.Es- .a:s}`.4.a yY..'::':S y4...�•..Y-`ice ...... - .-ry. ..... ,..a.s a...� :t_w.j�y Y- e,ti.in;:S..,...y,v�.,..::;siii.::,Laf.ti..,e.s..--r' n .. .. ..., -, ,.
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' DAVIE COUNTY HEALTH DEPARTMENT
--- _ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
- 'NOTE:=Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name Date
Locatio
Subdivision Name Lot No. Sec. or Block No.
Lot Size House 1� Mobile Home _ Business Speculation
No. Bedrooms -. F No. Baths _ =J No. in Family zt _
Garbage Disposal YES ❑ NO [x' Specifications for System:
Auto Dish Washer YES NO '❑ a
Auto Wash Machine YES NO ❑
Type Water Supply
"This permit Void if sewage system described below is not installed within 36 montbs-frSm date of issue.
1 J��,Gc1
V �l
s
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
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.