502 Griffith Rd (2) -' r DAVIE COUNTY HEALTH DEPARTMENT
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fir' IMPROVEMENTS PERMIT"AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a q -
Sanitary Sewage Systems -°� Permit Number
Name :/�j � / ' �' .%' ✓ �/�i' Date �.r _, s�� N0 5813
Location ,xllp /f '� I%rI/;/ / ' T
Subdivision Name Lot No. Sec. or Block No.
Lot Size f' House Mobile Home _ Business Speculation
i
No. Bedrooms — No. Baths No. in Family—�—
Garbage Disposal YES NO ❑ Specifications for System:
Auto Dish Washer YES NO ❑ - yY� '
Auto Wash Machine YES NO p
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.
4
Improvements permit by
*Contact a representative of the Davie County Health Department for final inspection f 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
Jib l bra
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Certificate of Completion /' Date
'The signing of this certificate shall indicate that the system described above has been installed in compli nce w 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.