352 McClamrock Rd Yip ; 3 0
� DAVIE: COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
3�l *NOTE:'Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Sys ems 7 Permit Number
Name %� ii i /� ��� �Date ��- h N°_ 7 7
1
Location /� ✓ �C :� , dl Y ��.n' F? /��� ��1�
Subdivision Name. Lot No. Sec. or Block No.
Lot Size House 1�� Mobile Home __T_ _ Business Speculation
No. Bedrooms No. Baths 4— No. in Family _
Garbage Disposal YES ❑ NO. Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Ma thine YES E]-N0 ❑
Type Water Supply
*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.
Improvements permit by _1
*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
Oo�
CUE J
✓6��
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F
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.
DAVIE COUNTY HEALTH DEPARTMENT 4
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
0 *NOTE:'Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
NameS11%/ //Date �'= -�? N2
'T 71
Location �.-� � ,-'?•,i-.�.-�, ��9`
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 []~ Specifications for System:
Auto Dish Washer YES ❑ NO p 4,
Auto Wash Ma,.hine YES NO r-1 � C�.-�' ,. �✓�
Type Water Supply
*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.
)_0
1
l=�
J / /
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
/ Oo
r
. _ T
Certificate of Completion � 9 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.