138 Deadmon Rd (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 X10 NCAC 10A .1934-.1968) Permit Number
Name ,; ���� /S �ci./r %If /_ Date
LocationT —
Subdivision Name Lot No. Sec. or Block No.
Lot Size House _ - Mobile Home -- Business Speculation
No. Bedrooms- No. Baths _Z_ No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ NO ❑ 1��_i�c,�.
Type Water Supply
`This permit Void if sewag `system described below is not instaithin 36 months from date of issue.
\ ;y
S
Improvements permit,by
*Contact a representative of the Davie C unty 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 ompletion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed
Certificate of Completion �1A7 � 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 as a guarantee that the system will function
satisfactorily for any given period of time.
j_ _