270 Hilton RdDAVIE COUNTY HEALTH DEPARTMENT
65 ' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Systems � Permit Number
Name s���fll —}',� .,,.,i, ,J% ril Date NO 580
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 Specifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Machine YES j NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
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.
i
f
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
* NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Systems Permit -Number
'Name. Date s� �/`
Location �,� �''"i �S"� .�/�„ /j� �/' . �/ 'i '%/�� -(-,� 'y
r
Subdivision Name Lot No. Sec. or Block No.
Lot Size House 1� Mobile Home Business Speculation
No. Bedrooms No. Baths 1 No. in Family �r—
Garbage. Disposal YES ❑ NO 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 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
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 byfi1iW/!n C��s�
Certificate of Completion _J =— Date -11 'Ire
"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.
STATEMENT
s '
• • DAME COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
210 HOSPITAL STREET
P. O. BOX 665
MOCKSVILLE, NORTH CAROLINA 27028
(704) 634-5985
DATE 01-23-90
Carl Dunn
c/o Sherman Dunn
Rt. 6, Box 249-3
Mocksville, NC 27028
Repair Permit 5817 - $50.00
L J
DETACH AND MAIL WITH YOUR CHECK. YOUR CANCELLED CHECK IS YOUR RECEIPT.
STATEMENT
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
210 HOSPITAL STREET
P. 0. BOX 665
MOCKSVILLE, NORTH CAROLINA 27028
(704) 634-5985
DATE 02-26-90
SECOND NOTICE
Carl Dunn
c/o Sherman Dunn
Rt. 6, Box 249-3
Mocksville, NC 27028
Repair Permit 5817 - $50.00 Billed 01-23-90
L— I
DETACH AND MAIL WITH YOUR CHECK. YOUR CANCELLED CHECK IS YOUR RECEIPT.