P3632 Davie Academy Rdw.+ "�+; ('� v. tr• .d .. .✓ G w yes e,[ ,.r ' 1:-�,ti' .�,, .1 ..?' w d'"y �•r
DAVIE COUNTY HEALTH DEPARTMENT 11y2_,7571/
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 _ Z ,i ��i. ,� AK Date �/% ;!f% N'
Location t� rG-l/ _ 1,4%;�—
Subdivision Name Lot No. Sec. or Block No.
Lot Size House ��� l Mobile Home Business Speculation
No. Bedrooms yf No. Baths No. in Family –�
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑, NO ❑! ,.r
Auto Wash Machine YES [� NO ❑
Type Water Supply - -i%= 1
"This permit Void if sewage system described below is not installed within 36 months from date of issue:
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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 Noa� �iprf`N�4
Com letion Dat,6
Certificate of p
"The signing of this certificate shall indicate that the system descri d 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.
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DAVIE COUNTY HEALTH DEPARTMENT)
IMPROVEMENTS PERMIT_ AND CERTIFICATE OF COMPLETION
'N -OTE: 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 �) �,:� ��'.r/ i� J Date !'Ji ��/ 2
Location
Subdivision Name
Lot No. Sec. or Block No.
Lot Size CT, S,W
House
,r
Mobile Home _ Business Speculation
No. Bedrooms q �!
No. Baths
No. in Family 2- - _
Garbage Disposal
YES p NO
2--
Specifications for Syste:
Auto Dish Washer
YES NO
p
Auto Wash Machine
YES NO
-p
Type Water Supply
'This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit by'/�'
"Contact a representative of the Davie County Health Department for final inspection Nof 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 1:: J, �6PkA-N 3k -t005
Certificate of Completion Dat
"The signing of this certificate shall indicate that the system descrid 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.