447 Richie Rd DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name Date ` r 7 - 70 N2 6 0®0,,..
Location e� �� �' ����5�1 \�\z"
Subdivision Name Lot No. Sec. or Block No.
Lot Size % C - House Mobile Home _ Business Speculation
No. Bedrooms S No. Baths No.`in Family_ „
Garbage Disposal YES ❑ _ NO ®^' --
Specifications for System:
Auto Dish Washer. , YES� ':NO ❑ -\z)
Auto Wash Machine YES [p/ NO ❑ 3by
Type Water Supply
*This permit Void if sewage system described below is not installed within'5 years from date of issue.
This permit is subject to revocation if site plans orthe intended use change.
_ I
\� 3 �
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 by flJ.wi.�
a Z
Certificate of Completion ( - 22Date.
*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.
• = DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF. COMPLETION 0'">
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
'SariitarySewage Systems _ Permit Number
Name ] 5 Date ' 7 U N2 6000-.
y
Location .�C
Subdivision Name Lot No. Sec. or Block No. i
Lot Size_�_— }"� House Mobile Home — Business Speculation j
No. Bedrooms No. Baths %' No. in Family
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer- YES (J3' ,,NQ❑
Auto Wash Machine YES 'NO
c\❑ 2 ��� r.,} L
Type Water Supply �aJ tC
N oc
*This permit Void if sewage system described below is not installed within`5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
Improvements permit by
!'*,Contact a;representative of the Davie County Health Department fors final inspection of this system between 8:30-
9:30 A.M.`W6r 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
/ 43 t
D
", _e,Date �X'aCertificate of Completion 2Z'- I/1�
I"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.