4359 Hwy 64W "a DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
- Permit Number
Name Date
Location I;Tr
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family 6—
Garbage
Garbage Disposal YES ❑ NO p�s Specifications for System: P"'--r' 1�-iL
Auto Dish Washer YES NO ❑
Auto Wash Machine YES p' NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed-within-36 months from date of issue.
+j7
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 ofdompletion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by oi3 c'j
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.