1137 Baileys Chapel RdSubdivision Name Lot No. Sec. or Block No.
Lot Size /�'� House — t--' Mobile Home _ Business Speculation
No. Bedrooms .r. No. Baths o2 No. in Family
Garbage Disposal YES . ❑ NO .Er-� Specifications . for System:
Auto Dish Washer YES NO ❑ r,
Auto Wash Machine YES W NO i] J? X
Type Water Supply _
*This permit Void if sewage system described below is not installed within W months from date of issue.
Improvements permit by ,," `=/-t ZZ
*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:
N
System Installed by sl:-4
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 COUNTY HEALTH DEPARTMENT
/
J
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:
Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
ewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968)
Permit
Number
Date
N2
5747
Location
'� / r� 1 / "y� � % ' _ 1 �✓ �%i� /��j��
ea
Subdivision Name Lot No. Sec. or Block No.
Lot Size /�'� House — t--' Mobile Home _ Business Speculation
No. Bedrooms .r. No. Baths o2 No. in Family
Garbage Disposal YES . ❑ NO .Er-� Specifications . for System:
Auto Dish Washer YES NO ❑ r,
Auto Wash Machine YES W NO i] J? X
Type Water Supply _
*This permit Void if sewage system described below is not installed within W months from date of issue.
Improvements permit by ,," `=/-t ZZ
*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:
N
System Installed by sl:-4
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 COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NOTE;Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
ewage Tre4tment and Disposal Rules (10 NCA 10A .1934-.1968) Permit Number
,'Name Me
Date tj
ion
Subdivision Name Lot No. Sec. or Block No.
Lot Size House I _"o Mobile Home Business __ Speculation
Garbage Disposal YES NO Specifications for System:
Auto Dish Washer YES NO
Auto Wash Machine YE S NO C1
Type Water Supply
*This permit Void if sewage system described below is not installed within e@ months from date of issue.
U ' `
�
~ - - - -
1�
,-
'
_
Improvements permit bv
*Contact o representative of the Davie County Heo|dl Department for final inspection of this myoh*m between 8:30-
9:30 A.M.
:@O-9:3D/\.yW. or 1:00'1:30 P.M. on day of completion. Telephone Number: 7O4'O34-5S85.
[��
Finalxso�ukaUon Diagram: ` Installed by
' `
-
Certificate of Completion Date
*The signing of this certificate shall indicate that the system described above has been installed in oomu|kanoa with
the standards set forth in the above regulation, but shall in.NOway betaken aoaguarantee that the system will function
satisfactorily for any given period of time.