P3687 Baltimore RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with &S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name ._.?:�;�� t-�c� i~�i r' y L�`- iii a✓.�f' g� `i .J - �?i t`j f3687
Date
,
Location ; �' 12 i 'ivy �t c. , �h�o.2 �- I srt ?S fL �� 4 �"'yj U�
1 7 S r" 1��A�tcE{1tn`r IZ�.
Subdivision Name Lot No. Sec. or Block No.
- Lot Size House Mobile Home _ Business Speculation
No. Bedrooms —3 No. Baths No. in Family -
Garbage Disposal YES ;❑ NO ❑ Specifications for S�rstem:
Auto Dish Washer YES p NO E]
Auto Wash Machine YES �] NO -❑
Type Water Supply !it/� cC_
'This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by„
rte i '3-f- 0 L- ')
4 �-,• Lir-- U -r! •-I�°� F�l Ic .
r
`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�tL
Certificate of Completio Date / 7
'The signing of this certificate shall indicate that the system describ d 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.
.: .... a l:i-v-a.:-:v ..y v.,Le-I' ..•. ♦..� ... _ _ ..
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
ffj c�
Name ]:�6 (T Py, f cv s i � f 1° Date 1`� _ � � � s 3 687
� 4
Location fZ 7 EA
t.'
Subdivision Name Lot No. Sec. or Block No.
Lot Size House ° ` Mobile Home — Business Speculation
No. Bedrooms --_ No. Baths
Garbage Disposal YES p NO F]
Auto Dish Washer YES Q NO p
Auto Wash Machine YES p NO •p
Type Water Supply I.Aji r %
No. in Family 3—
Specifications for System:
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
F P, 0t -4-r
Improvements permit
C114C F,
*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�il-Lt►aZ'v
Certificate of Completio�t Date1 -1 7
9
*The signing of this certificate shall indicate that the system describid 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.