743 Godbey Rd .1.\ Ci
s DAVIE.-COUNTY HEALTH. DEPARTMENT:.-
IMPROVEMENTS
EPARTMENT .IMPROVEMENTS PERMIT AND. CERTIFICATE OF COMPLETION
*NQT�' Issued in Compliance with G.S. of North Carolina Chapter 13 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 110A,1�,34jr1968) Permit Number
lame �atel
Location Ci x)',•�A'F' . ,:, ' `" 1' � '`
Subdivision Name Lot No. Sec..or Block No.
Lot Size House %' Mobile Home _ Business Speculation
No. Bedrooms ,t No. Baths — y ' No. in Family
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO
.Auto Wash Machine YES ❑ NO 111
J
r
Type Water Supply
*This permit Void if sewage system described below is//�olfislled withi "36 months from date of issue.
Improvements permifby
`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. Telephonb`Number: 704-634-5985.
Final Installation Diagram: /oma, System Installed by_ Q
i7
7
1•
Certificate of Completion Ckt
P ._,.
"The signing of this certificate shall indicate that the system described above has been installe
the standards set forth. in the above regulation, but shall in NO way be taken as a guarantee that
satisfactorily for any gven period of time. F