2125 Hwy 601S (2) 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 .
x
Name _ ` .-u .�,� , Date
Location
SubdivisionName Lot No. Seca or Block No.
Lot Size House Mobile Home_ Business Speculation
No. Bedrooms No. Baths No. in-Family
Garbage-Disposal ' YES E) NO
Specifications for System:
Auto Dish Washer YES p NO
.Auto Wash Machine YES p -NO p
Type Water Supply
*This permit Void if sewage system described below is not installed within 36.months•from date of issue.
f;
Improvements permit by
'Contact a representative.of.the Davie County Health Department for final inspection of this system between 830-
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 \J
lv
• o� 0
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.
t .
' , DAVIE COUNTY' HEALTH DEPARTMENT'
IMPROVEMENTS PERMIT AND :CERTIFICATE 'OF COMPLETION
'*NOTE:' lssu"dd in:Compliarice with,G.S.'.of .North Carolina` Chapter 130 Article' 13c
'f SeWdgd:Treatment'and Disposal.Rules (Jr0 NCAC 10A'.1934-..1968) . Permit Number;
` Name Date
Location, ;
Subdivision-Name Lot No. Sec. or Block No.
Lot Size House �' Mobile Home Business - Speculation
No. .Bodrooms, No. Baths No.in Family •. ,
Garbage-Disposal. YES .Or NO.3,:'
Specifications for System:
.Auto Dish.Washer `=YES •R- NO 'p t•, �- � '
Auto Wash Machine ,YES. Ej,.•NO
Type Water Supply
`•This permit Void if sewage system. described below is.not installed within 36,.-months..fr.om, date of issue.
4� •J
Improvements permit by
Contact a:cepresentative.of,the Davie`County'Health Departrrient for final inspection of this system between 8:30-
9:30•A.M.'ori 1:00.1.30 P.M. ,on day. of•,completion: Telephone Number: 704-634-5985..'
' Final lnstallation•Diagram: :,System Installed by
wF AS . spa
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 re'gulation,,but shall in NO way,be taken as aguararitee thatthe,system will function
•:s'aiisfactorily for:any given'.period of time