P5316 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT 1
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
31qOTE 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
'I Name -F ✓ -% �i ate / //y��'9f N2 5316
Location _
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business _ l''_ Speculation
No. Bedrooms IL/4 No. Baths No. in Family64
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES ❑ NO���o
Type Water Supply ! d 0.
*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
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Certificate of Completion /,� AGG� Date
"The signi of this certificate shall indicate that the system described above has been installed in compliance with
the standa s set forth in the above regulation but shall in NO way be taken as a guarantee that the system will function
satisfactoril or any given period of time.