P5572 Bear Creek Church RdDAVIE 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 {�,� .��r�' .Grs =��Date N2 5572
Location �ni�: .�i f',%���Y -� /�/��— / �'%✓<" . i>�'r�
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Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms off. No. Baths _Z_ No. in Family
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES NO 0 /jr �/" I �
Auto Wash Machine YES NO p �i�� / / /a Cy
Type Water Supply
"This permit Void if sewage system described below is not installed wihQ,36 months from date of issue.
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Improvements permit by Z�
*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.
9 Y Y -- � �� T r
Final Installation Diagram: System Installed b d 11..r ��
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Certificate of Completion Date <S
'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.
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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-.196/8) Permit Number
Name ���• ' /5i��< -iy /_� ;,'.,�/ Date ` ms's/�_ _. �_ N2
5572
Location
v �J'J'1i � a.- �'" �� lu� z-'i� /--��.c�a"/ 1./1L7'`�`•-� ,•�.'. �,,,, y`rJ,fi�,' .� �di7 �
Subdivision Name
Lot No.
Sec. or Block No
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms c52-- No. Baths No. in Family_
Garbage Disposal YES p NO g'
Specifications for System:
Auto Dish Washer YES NO p
Auto Wash Machine YES W NO
Type Water Supply
*This permit Void if sewage system described belo�is not installed hi 36 months from date of issue.
,6—",
CIj�`,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
r
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. „
4