P2378 Boxwood Church RdDAVIE COUNTY HEALTH DEPARTMENT jxw
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name ` " �_�,'kvDate
C { 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 YES ❑ NO p -' Specifications for System: " -; -;,•
Auto Dish Washer YES ❑ NO El
Auto Wash Machine YES ❑ NO i❑ /� J } . '� f...•:L.f
Type Water Supply ` --
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
-
Improvements permit by
a.
*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 w�,
S. I ��
Certificate of Completion - m &KJo Date
indicate that the system described above has been installed in compliance with
The signing of this certificate shall in y
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.