113 Bethlehem Rd (4) s ` �241>
" 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 6Laz2�' .5p-1,TN Date 2 �3 `610- 3330
Location IS8 7—c fZ �� N� �1�r/ XT _57,
(-5. 7
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home - Business Speculation
.No. Bedrooms No. Baths No. in Family Z_
Garbage Disposal YES ❑ NO ❑ Specifications for System: /��/�-
Auto Dish Washer YES E] NO ❑
Auto Wash Machine YES ❑ NO -❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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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 byT I LLQ
Certificate of Completion Datev
*The signing of this certificate shall indicate that the system descri d above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way b 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-.196 ) P@I'lll'tit Number
-Name �L. �/L� J/ri�Tf-1 Date �` � �3 ����, 3 n
°
Location �S8 `TD /1�/-��.gN> T�E�/ XT
7-
Subdivision
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family Z
Garbage Disposal YES ❑ NO ❑ Specifications for System: jejj 1 yfL
Auto Dish Washer YES ❑ NO ❑ p a'X 3'
Auto Wash Machine YES ❑ NO ❑
Type Water Supply (Is) �Z 5;=
r
*This permit Void if sewage system described below is not inst Iled wilfln 36 months from date of issue.
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Im rovements permit b
_ P P Y
*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 k Ill.I-J a,p
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-------------------
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Certificate of Completion Da
*The signing of this certificate shall indicate that the system desc ' ed above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way a taken as a guarantee that the system will function
satisfactorily for any given period of time.