P4964 Cedar Grove Church Rdi
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
Name - �,�:- �; t., Date#
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 p NO [� Specifications for System:
Auto Dish Washer YES O . NO
Auto Wash Machine YES f'7 NO Q
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
*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