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708 Williams Rd DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION `Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number fk N-1 . ._ ^ r � r.- Name t�' Date Location t_j c_ Tb JIJC, C R i>. X1'7cL//I J.. Subdivision Name Lot No. Sec. or Block No. Lot Size 2` � House `"�^r Mobile Home __ Business Speculation No. Bedrooms ?' No. Baths �`"" No. in Family " Garbage Disposal YES ❑ NO © Specifications for System:C70© Cj=t . —7 Ij It, Auto Dish Washer YES ❑ NO .E] j� Auto Wash Machine YES © NO 0 oCD rY � .�; l g S T�/`� Type Water Supply "This permit Void if sewage system described below is not installed within 36 months from date of issue. r l L1 4' Improvements permit by %t' l� '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 Z _ 3/,t CAL(/ 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. DAVIE COMITY HEALTH. DEPARTMENT . ENVIRONMENTAL HEALTH SECTION -P. O. BOX 57 MOCRSVILLE, N.C. 27028 (704) 534-5985 Pd Statement for Septic Tank Improvements Permits and/or Site Evaluations i NAME �j�L�IhyN. L. �VR'�Iv DATE 4 Y;.i;. ADDRESS ' "- PERI-11T 110. Z�d EXPLANATION OF CHARGE r 1 m P/�1/f.I�+�.►�s ,ri.w�-LST' A140M T°,D -7-0' SANITARIAN PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT. *NOTICE: Evaluations) can not be completed until payn+ent is received. Improvemahts Permit(s) can not be issued until payment is raceived..