5395 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT
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 —Date-�-Z� �� 3502
Location 1k:7,2
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No. Bedrooms— No. Baths No. in Family 2 -
Garbage Disposal YES ❑ NO ❑
Specifications for System:
Auto.Dish Washer YES ❑ NO ❑
/00 "A' ,3 ">eAuto Wash Machine YES ❑ NO ❑
Type Water Supply �' ��N; ;• _ __
i E �
*This permit Void if sewage system described bglov4 is not installed within 36 months from date of issue.
ST�=t DOw►`� � F fJ£Cf5SR2y
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Improvements permit
"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:
em Installed by �revr► a,�.�
Certificate of CompletionDate
`The signing of this certificate shall indicate that the system describ 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.
~' DAVIE COUNTY HEALTH DEPARTMENT
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 ��)� ��yCL Date•3 2`^'I �7 DSP 2;02
Location IS 2 � A5 -r A c a.5 s � rz, SE r- Co
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms _ No. Baths No. in Family 2--- _
Garbage Disposal YES ❑ NO ❑
Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ NO ❑
Type Water Supply _ W)
*This permit Void if sewage system described berloq is not installed within 36 months from date of issue.
�C !;Al2 y
). P I./ri
li-
Improvements permit
`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:
[em Installed byA(-f�^�2��-tom
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.