226 Burton Rd (2) ..,:pe,.„-.a�^ �_:.� .,.�.., n z ;i .i ... , ..o,. .:.•sJ., _i:--:'e... .}w'.-Ltit, ,.y:,.. S'.e.:.k,,.i.S. ,u.=a:
DAVIE COUNTY HEALTH DEPARTMENT
_ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter X130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name /X- _ ,�i �1'�/S > �' i 02
Location
�
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No. Bedrooms r' No. Baths No. in Family--
Garbage
amily _Garbage Disposal YES :p NO Er Specifications for System:
Auto Dish Washer YESNO
Auto Wash Machine YES LJ NO
Type Water Supply
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by %=r
*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
r�
Certificate of Completion - Date
*Thi ning of this certificate shall indicate that the system described above has been installed in compliance with'
hdards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
Itorily for any given period of time.