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P2502 Gladstone Rd
,,,✓a:, -. 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 Name !� i L t . Date Location U ( >G.r'4 i� +_ r` �E �� 1.%,��.: n1 �i L cit rr I<!. J r -S Subdivision Name Lot No. Sec. or Block No. < t`� Lot Size House Mobile Home _ Business Speculation No. Bedrooms •' No. Baths a +` `' No. in Family Garbage Disposal YES ❑ NO © Specifications for System: C/o Auto Dish Washer YES ❑ NO p '01 Auto Wash Machine YES M NO E]O `� 'k = Type Water Supply f t-�,Ur l r `f __ -f� - l u,.; Dr,1 CCt.►t /l.f/ C Si- fi ; *This permit Void if sewage system described below is not installed within 36 months from date of issue. Improvements permit by `. — �; C I "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 lof completion. Telephone Number: 704-634-5985. Final Installation Diagram: I '-,.__j r i T� System Installed by �TfLOUjZ 0s_ - .1y FE,« 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. DAVIE COMITY HEALTH DEPARTMENT ENVIRONMENTAL HEALTH7SECTION P. 0. BOX"57 MOCK.SVILLE, ` N. C. 27028- (704) 634-5985 Statement for Septic Tank Improvements Permits and/or -site Evaluations NAbM G L iP� y ., . � . DATE 7 — I t j 20 ADDRESS � -.. PERMIT 140. rs EXPLANATION OF CHARGE s. AI401r4T AZQ- SANITARIAN PLEASE REMIT THE ABOVE AMOUNT ON RECEIPT OF' , 'THIS 'STATEMENT. *NOTICE: Evaluation(s) can not be complete.d. _until payment is received. Improvements Permit(s) can not be `issued until payment is received.