461 Riverdale Rd DAVIE COUNTY HEALTH DEPARTMENT
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IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION sir
:NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name �� e �� � \ \� Z\� Date N0 6225
Location
6D 0
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 p'. „ Specifications for System:
Auto Dish Washer' YES p' NO EJ C,c o
Auto.Wash Machine YES NO ❑ C
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 or.the intended use change.
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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-
0 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
1540
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..
s 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 N2 6225
Location '� y �` ; c'1 )T �)C__ •�.,-�_�\_`—=_> , `:
Subdivision Name c :L�_ Lot No. Sec. or Block No.
Lot Size House>,3 V Mobile Home _ Business Speculation
No. Bedrooms No. Bats rn No. in Family
Garbage Disposal YES ❑ NO p'
Specifications for System:
Auto Dish Washer YES 0- NO ❑
Auto Wash Machine YES NO ❑ r N,
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 or the intended use change.
i.
f Improvements permit by `
*Contact a representative of the Davie County Health Department for final inspection of this syste[n, between 8:30-
A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
Certificate of Completion '41! 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.