822 Sain 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
See/wage Treatment and Disposal Rules (10 NCAC 10A' .1934-.1968)'* Permit Number
Name Date 37
Location L
Subdivision Name Lot No. Sec. or Block No.
Lot Size (t,. • House Mobile Home — Business -- Speculation
No. Bedrooms No. Baths 7_ No. in Family ��
Garbage Disposal YES ❑ NO g- 3�,�� �• -� Specifications for System:
Auto Dish Washer YES Q' NO ❑
Auto Wash Machine YES d NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
� r
C
_,
Improvements permit by -0- S
*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--� /�'-� 4
x
T /
(r
fJ f
Certificate of Completion Date �� 1
*The signing of this certificate shall indicate that the-.system ded bove has been installed in compliance with
the standards set forth in the above regulation, but shall in NOescrie taken as a guarantee that the system will function
satisfactorily for any given period of time.