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D DAWE COUNTY. HEALTH DEPARTMENT Y
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a .
Sanitary Sewage Systems
Name t r�i 11 Date _ 1
Location ,
Permit Number
N2 6 Ij l -r
Subdivision Name Lot No. Sec. or Block No.
Lot Size House _i Mobile Home _______ Business __ Speculation
No. Bedrooms .No. Baths _2 _ No. in Family � _
Garbage Disposal YES ❑ NO E Specifications. for System:
Auto Dish Washer YES NO ❑
Auto Wash Ma.hine YES NO ❑
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 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.
.4
Final Installation Diagram:
System Installed by
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.
� �= DWE COUNTY HEALTH ,DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
..'NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
= Sanitary Sewage Systems
moi- �9�''
Name�F�� ,�— �l Date�—
Permit Number
No ^ I'
Subdivision Name Lot No. Sec. or Block No.
Lot Size House _i Mobile Home ___ Business __ Speculation
No. Bedrooms —,,'2,—.No. Baths �2_ No. in Family__
Garbage Disposal YES ❑ NO e' Specifications for System:
Auto Dish Washer YES T NO ❑
Auto Wash Ma^hine YES NO ❑ �3S/,�/��/���
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 if site plans or the intended use change.
I
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 '� Date
"The signing of this certificate shall indicate that the system descri ed 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.
70,