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�'S': a M DAVIE COUNTY HEALTH DEPARTMENT
p� -;? 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 1(10 NCAC 10A .1934--.1968/) Permit Number
Name 1V Date s1L� 7Ar_e / N2 .5481
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House_T— Mobile Home �—' Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ;❑ NO Ery Specifications for System:
Auto Dish Washer YES p NO ❑ ,
Auto Wash Machine YES [ ] NO ❑
Type Water Supply e -A' y _
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
-
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j
Improvements permit by
*Contact a representative of the Da tie-Gs h Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P day f co pletion. elephone Number: 704-634-5985.
Final Insta lation Diagram: £ ystem Installed by
J
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
Sew.rage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968),--i Permit Number
.�� ��la e��:"�✓ f`Y`��/r1�✓�„rr'�!�>>�•'X r%�a �'%r� % Date �� 0 �.� �
Location
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 p NO ET---
Specifications for System:
Auto Dish Washer YES NO ❑
J
Auto'Wash Machine YES j NO ❑ �-S�'X j�/
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
wY tir�
Improvements permit byte
—,
*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..Mr-on day f co pletion: Telephone Number: 704-634-5985.
Final Installation Diagram: !% System Installed by �
t
r
f
i
Certificate of Completion T 4C Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
,thEi'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.