275 Walt Wilson Rd ®j DAVIE COUNTY HEALTH DEPARTMENT o
p- � IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
i *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
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Sewage Treatment and Dispos I Rules (10 NCAC 10A .1934-.1968) Permit Number
Name.t/ �f �!� �/?���r1 f' '.�/�j� Date //�S',�3'f% N2 5767
Location
Subdivision Name Lot No. Sec. or Block No.
Lot SizeHouse �� Mobile Home _ Business Speculation
No. Bedrooms No. Baths F No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer . YES ❑.r NO ❑ SQc
Auto Wash Machine YES ❑ NO
Type Water Supply `
60 Zdb
'This permit Void if sewage system described below is not installed within-OTmonths 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 1
"The signing of this certificate shall indica'e that the system described above has been installed in compliance with
the standards set forth in the,above regulAtl�-�, shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time. /