503 Richie RdZ:oo
DAVIE COUNTY HEALTH DEPARTMENT.
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
,i .
Name f ` _ 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 NO
g p ❑ ❑ Specifications for System:
Auto Dish Washer. YES ❑ NO ❑
Auto Wash Machine YES ❑ NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
f ,r
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:
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r\ >,0�"
r
tl System Installed by
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('tsjA
a�14G�9
1" S
Certificate of Completion Date ` ' XL
*The signing of this certificate shall indicate that the system describe 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.
�:c7O
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
f Permit Number
Name Nk'-4 Date
Location / /t/ r/. ,. .5 �`'' /lovS £ C%✓ ,C'/G/t 7
Subdivision Name
Lot Size House
No. Bedrooms- �' "� No. Baths
Garbage Disposal YES :❑ NO ❑
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ NO ❑
Type Water Supply cli f t L -
Lot No
Sec. or Block No.
Mobile Home -- Business Speculation
No. in Family I _
Specifications for System:
*This permit permit Void if sewage system described below is not installed within 36 months from date of issue.
r- OL L i/vf /S -S-7 /L
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:
� tl
System Installed by ' � C7Dy4jrZ �
1 �
7
Certificate of Completion -� ��� Date i
*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 th t the system will function
satisfactorily for any given period of time.