3432 Hwy 601S (3) i ... ;-DAYIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS -PERMIT AND CERTIFICATE ij OF COMPLETION'
NOAE: Issued in'Compliance with G.S. of North Carolina Chapter 130 Article 13c' -
�} Sewage. Treatment and Disposal Rules (10 NCAC 10A'.1934-..19 68)! Permit Number.
Name / �liif� �. I�a.,o , �� :�i � ;: ,/ e 20
�ii
4i `! Location ?,!ri�
Subdivision Name Lot No. !�'' Sec. or Block'No.
Lot Size �� " House "� Mobile Home — Business Speculation
j No. Bedrooms Alkly No. Baths - _ No. irn Family
j. 'Garbage Disposal YES p ' NO
Specifications) for ,System:.
iAuto Dish Washer YES E] NO 1 r ,,
4
`Auto Wash Machine YES Q, NO
{i Type Water Supply -- j
!. 'This permit Void if sewage systemdescr�ibed'below isnot installed 'thin 36 months from date of issue.
17
0v)' ftp I .
C} it •� �!• • - �• � -. •,;
r ` Improvements permit.by .
- +�• -
'Con'tact arepresentative 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 dayof completion: Telephone Number: 704-634-5,985
', tii • +t • . Vii; . .,: . .
Final Installation Diagram: I� System Installed by2i-
: � '� _ `• ala . . • .
• �,� it' .. - :. • ,:, L' ,• . ,� �� .
++ dertificate',of Completion Date
. The signing of this certificate shall indicate that the system described above hag. 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. :