130 Swicegood St • -�' "ter-`°^w-r-rpr .�:.^:.c�-..-y:,.-.«:�-��..c�rs..�,-.�;..s.e M - .. . .
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DAV'IE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
-*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permii7t Number
Name -e7 /'S �0 Date /,3--9� No 1564
/� 0r7 iii r C
Location 5� rte? �➢�
Subdivision Name Lot No. Sec. or Block No.
Lot Size House _Letf!:�:_ Mobile Home Business __ Industry
No. Bedrooms .No. Baths No. in Family Public Assembly Other
Garbage Disposal YES ❑ . NO .2 Specifications for System:
Auto Dish Washer YES NO ❑ r,
Auto Wash Ma^,hine YES NO ❑
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.
Improvements permit bY — a!1
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985.
Final Installation Diagram: System Installed by
Certificate of Completion _L" Date 1 _
'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
fNOTE:',Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
armee is �'� y Date �`/.�-9ti' N° 7564
._�✓ Name ..
l67a, .r r t-'<
/�
Location CSO/_� - �� � '/ fes^ jr " Qr! "Op/
Subdivision Name Lot No. Sec. or Block No.
Lot Size _— House j — Mobile Home Business -- Industry
No. Bedrooms rV- .No. Baths _L___ No. in Family_�_ Public Assembly Other
Garbage Disposal YES ❑ NO Specifications for System: --
Auto Dish Washer YES NO ❑
Auto Wash Ma^hine YES NO ❑
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
r
r
Improvements permit by
a
P P
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A,M.,
Ila
1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985.
Final Installation Diagram: System Installed by ,
- F
Certificate of Completion Date 1 L^a
'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.