P4926 McCullough Rd eA
'VC DAVIE COUNTY HEALTH DEPARTMENT
r IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Se/wage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name ��lf�,r/, ws C��/�G--�!/J-y %y ��'`' Date /��`�'� �, i� 4926
Location
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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 p NO [D-- Specifications for System:
Auto Dish Washer YES p NO p �� / �' - C% �
Auto Wash Machine YES NO • ]
r
Type Water Supply _
*This permit Void if sewage system described below is not installed within 36 months from date of iss e.
Improvements permit by
*Contact a representative of the Davie County H alth Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of comple on. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by IV A
�7 /,,
f g "A
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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, 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 �/% i r �"t�;
c 34
A
Location C ' I-If
- :'� ✓ /,; ��' ,' ,�, f'i1' ,/. _ !. ,r
Subdivision Name Lot No. Sec. or Block No.
Lot Size House �� Mobile Home _ Business Speculation
i No. Bedrooms No. Baths l No. in Family
Garbage Disposal YES ❑ NO p--'
Specifications for System: �f
Auto Dish Washer YES NO ❑
Auto Wash Machine YES NO ❑
Type Water Supply 1y _
*This permit Void if sewage system described below is not installed within 36 months from date of iss e.
1 L
1
Improvements permit by --
*Contact a representative of the Davie County H alth Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of comple ion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by f �°: -�� `�>>
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.