P3973 Sain Rd 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 -� Date �'.��tet' i`')�' '3
Location;
Subdivision Name Lot No. Sec. or Block No.
Lot Size House L"� Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO,E]' Specifications for System:
Auto Dish Washer YES ] NO ❑ r- r _�-
Auto Wash Machine YES NO ❑ t/
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 by 9
Certificate of Completion ` - !a %' Date
*The signing of this certificate shall indicate that the system described above has been instal led'i c plieQ 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.
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