946 Yadkin Valley Rd S
e� t L4_
DAME COUNTY HEALTH DEPARTMENT
✓ IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
*NOTEAssued in Compliance With Article I I of G.S.Chapter 130a
�S-aniita Sewage Systems Permit Number
Name-L ��P �f/ G�/,S�S / Date N2
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _T Business _ _ Speculation
No. Bedrooms c_.No. Baths No. in Family
Garbage Disposal YES ❑ NO 2-- Specifications for System:
Auto Dish Washer. YES NO ❑ y
Auto Wash Ma.hine YES NO ❑ � �� =�-. �Ovx 3 �a� l
Type Water Supply __—
*This permit Void if sewage system described below is not installed within 5+erdars from date of issue.
This permit is subject to revocation if site plans or the intended use change.
_wood
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Improvements permit b
*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
Li
Certificate of Completion HN Date �ZA
*The signing of this certificate shall indicate that the system describ d 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.
i - 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= ire �' f Gjl/T_S' X,�'=�i Date .a/. l._,?-<9 N2 �'
Location'' i//!/ 4a��,�r��/Sri �7
Gam• �
Subdivision Name Lot No. Sec. or Block,No.
Lot Size House Mobile Home —_ Business Speculation
F'
No. Bedrooms-'-; No. Baths No. in Family _
Garbage Disposal YES ❑ NO g-- Specifications for System:
Auto Dish Washer YES , NO ❑
Auto Wash Ma shine YES lll. NO ❑ ;�—,' ��-��_. �Q�j3X/a2 J1
Type Water Supply e!::0 _
*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.
t
r
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
JI
Certificate of Completion Date �j /
P �
'The signing of this certificate shall indicate that the system describdd 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.