P4997 Cornatzer RdDAVIE COUNTY HEALTH DEPARTMENT,
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 0
`NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c �
Sewage Treatment an`d,Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name�:a_;R>_.ti�,j C Date r�� t,�i7
L
Location . l' IF— �"- -
Subdivision Name Lot No. Sec. or Block No.
Lot Size House t Mobile Home _ Business Speculation
No. Bedrooms No. Baths J No. in Family _
Garbage Disposal YES ❑ NO p Specifications for System:
Auto Dish Washer YES ❑ NO p
Auto Wash Machine YES pi NO -❑
Type Water Supply 1 "1i.' tj :> ` �. --
*This permit Void if sewage system describe
t°
`)
below is hot installed within 36 months from date of issue.
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.
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.
r
•'' DAVIE COUNTY HEALTH DEPARTMENT l ,�
jMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION, 1 ' 3O
e *NOTE': `Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c �'U V
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
C, , II
Name ` <�, - r- C4 �\ Date 9 ;��
t.
Location
r
Subdivision Name Lot No. Sec. or Block No.
Lot Size r'
House Mobile Home _
No. Bedrooms — ` No. Baths ! — No. in Family
Garbage Disposal , AYES ❑ NO p
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES [:3,, NO ❑
Type Water Supply " 1
Business __ Speculation
Specifications for System:
`This permit Void if sewage system describe below is not installed within 36 months from date of issue.
.w: -
B�, N
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.
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.