271 Buck Seaford Rd (2)OAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
Note: Issued'in Compliance with G.S. of North Carolina Chapter 130—A-1cle 13c.
Name 'r '!_� &�4tlryr Date
Location
Permit Number
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 1❑ NO K
Specifications for System: j(p;
Auto Dish Washer YES NO ❑��
Auto Wash Machine YES [ NO 17 f W
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
R
Improvements permit by # • ' `` i'
*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.
// r.
Final Installation Diagram:
System Installed by
Certificate of Completion •s% ���r' Date . 4 4
*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_