P3006 Cana Rd,0 r
1 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
DAVIE COUNTY HEALTH DEPARTMENT
Permit Number
Name i -/4 Date
Location
Subdivision Name
Lot No. Sec. or Block No.
Lot Size fir'
House
Mobile Home _ Business Speculation
No. Bedrooms -
No. Baths
No. in Family
Garbage Disposal
YES ❑
NO ❑
Specifications for System._ /
Auto Dish Washer
YES ❑
NO ❑
Auto Wash Machine
YES ❑
NO i❑
Type Water Supply'
`This permit Void if
cribed below is not installed within 36 months from date of issue. _
1 � % ,
Dermit 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 CompletionDate %/f
*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.