P3167 Peoples Creek Rd s 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 \j}:..i"t.! Date
Location J'
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 ❑ NO ❑ Specifications for System: :' tf�r
Auto Dish Washer YES ❑ NO ❑ N
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.
t '
1
f �r
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 byJ)'�9 er!E.
Li
��' Its •
Certificate of Completion Date /
' #Thesigning of this certificate shall indicate that the system descri ed above has been installed in compliance with
%*t standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
+isfactorily for any given period of time.
-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 .i,
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House "'f Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO ❑
Specifications for System:
Auto Dish Washer YES ❑ NO ❑ / i
Auto Wash Machine YES E] NO ❑ �'�
Type Water Supply W€t C- __—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
F
"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-Yll AZA �6 �
1
Certificate of Com letion--'; , Date �--�
_ p
The signing of this certificate shall indicate that the system descri ed above has been installed in compliance with
he standards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
factorily for any given period of time.