165 Underpass Rd Zai
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-.1�9j68) Permit Number
Name ml(. lzer) WARD :5p/v Date d `f - S-f� ?' u7
Location VNDMPA-r.5 (Zp, -P1AGuY.A,'-I /4---mors rf�o - S 609-J-4 z�c-s F{r,1rt
1(P5_ Ne, 27yoo
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 :E:]. NO B�
Auto Dish Washer YES NO p Specifications for System: 2 �
Auto Wash Machine YES NO p /00 1C� X 2� I /-b, �E
Type Water Supply U _
'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
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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.
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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 MILD a 2 D 5 P tIS-( r
Dates y 36119
Location1'/
/V 6, -?,70 6�
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business -- Speculation
No. Bedrooms No. Baths _ d No. in Family —
Garbage Disposal YES ❑ NO 13 Specifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Machine /0 O J(� X 2`�
Type Water Supply CnUtJl:!�
"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 — "=--1
"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.
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Final Installation Diagram: System Installed by t.1
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Certificate of CompletionDate
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"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.