129 Fernwood Lane Lot 20• 'rVs"t"a8V P• -• W:—T:r: , s�yy. iyj"'y-.+"*ru-`+V.+ryr.r",�;�3F'szr.� --ir-y-vr`""5'�3'i:"lt:+r ^+rt �9t'�Cd'^^"'v'a°.�gri"ti"w:-.s-Y'$.i,'...�,.;.'�'"'."'lti °4'f� �"'�- ,ro Gj,�'•.w:�a a p i )X
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF. COMPLETION
*NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
nitary S�j�^�age Systems _ / / Permit , " igr
Nam e �`M y /70W P��IQ�J`fi�lvo�d�7r✓I p 8t/a�/92 No b �ti t�
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business _— Speculation
No. Bedrooms ! No. Baths No. in Family
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
YES
NO ❑
YES
NO ❑
YES
❑
/0
Specifications for System:
*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.
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
Certificate of Completion-__-1�` `G�'-- Date
':The signir�g'of this certificate shall indicate that the system described above has been installed in compliance with
the stan,Ards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
Satisfatonly for any given period of Time.
PA
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
unitary ewage Systems Permit 11�nl�er
Name-
Location
am /r %��F�`�a?G f92 Np t3 t i
e -
lLocation — -
Subdivision Name Lot No. Sec. or Block No.
s Lot Size House Mobile Home Business Speculation
No. Bedrooms No. Baths No. in Family —
Garbage Disposal YES NO ❑ Specifications for System:
Auto Dish Washer YES NO ❑ /+JD
Auto Wash Machine YES ❑ ,NO ❑
0
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 it site plans or the intended use change.
i
If
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:
i
System Installed by �
rl -
Certificate of Completion J�{G Date
'The signing of this certificate shall indicate that the system described above has been installed in compliance with
the stanbards 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.
t7
t.