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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 1
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c 1 N
Swage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Named �� ��a,/ �Y/% Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House �Mobile Home _ Business Speculation
No. Bedrooms_ No. Baths o2 No
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
YES ❑ NO ❑
YES ❑ NO ❑
YES ❑ NO -❑
in Family ;_:: � —
Specifications for System:
`This permit Void if sewage system described below is not 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.
Final Installation Diagram:
System Installed by
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.
>.....':-. .v.Y.nfi+(.:1 -yin.,-M ..1 - � •✓ �v .r. .. e•'F � -,•-.. - ,
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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 .19344-.1968) Permit Number
NameDate
Location
Subdivision Name Lot No. _ Sec. or Block No.
Lot Size House 4 -----Mobile Home _ Business Speculation
No. Bedrooms c,2'— No. Baths o2 No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑ _ , „
Auto Wash Machine YES ❑ NO .7�i(�r1
Type Water Supply _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
If �
r
I
J
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.
Final Installation Diagram:
System Installed by
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.