241 Pine Ridge Rd ID
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G:S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name QS r,�2 (' a Date 3 6 d 1
Location (ro/5 - 7%�'c /� ��rc ? - �Jh:�+- C7�+r� an /c F f ��� 1. ���1^ ��z �., U—
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms 3 No. Baths t No. in Family 3
Garbage Disposal YES ❑ NO ❑ NY Specifications for System:
Auto Dish Washer YES ❑ NO ❑ 3,Y
Auto Wash Machine YES ❑ NO ❑
Type Water Supply _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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provements permit by
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*Contact a representative of the Davie County Heal t Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completio Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by ?-eZX7 l7�D.�o�✓
Certificate of Completion1 `&JO Date
*The signing of this certificate shall indicate that the system describe 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.
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?' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: ,Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number.
Name �^fi: . �, (' Date �' /�:� - U 31
le �
Location � ��5 �;�,� ,r'. ,./,; ,r �,�L,: rte• :, n ! f '/-�- '/z ,,., �
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business ._TT_ Speculation
No. Bedrooms No. Baths i No. in Family 3 _
Garbage Disposal YES ❑ NO ❑
Specifications for System:
Auto Dish Washer YES E] NO E] Specifications
Auto Wash.Machine YES ❑ NO ❑ 7.� " �� � 'Y.,�
Type Water Supply —
"This permit Void if sewage system described below is not installed within 36 months from date of issue.
f
i
i
rovements permit by
"Contact a representative of the Davie County Heal t Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completio Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by –rEZz7
�eti�w
a
Certificate of Completion Date
"The signing of this certificate shall indicate that the system describ id above has been installed in compliance with
9 9 Y P
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.