P2874 Hwy 601N-t—IT
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 _ .. ; ,4 i �' Date
Location y —
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 ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ N0 -❑
Type Water Supply-. _._.. ---
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
f
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:
.... 7�1i1 ^0 Y"J
Certificate of Completion �``� Date 12
*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.
' Permit Number
Name __1 a u.,.- ;'J: t ' Date �``J ' 2f,7(
Location !r r."tj�;i� - �-r,A,,,
Subdivision Name
Lot No
Sec. or Block No:
Lot Size l"' House Mobile Home _`"� Business Speculation
No. Bedrooms y No. Baths No. in Family
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 36 months from date of issue.
Improvements permit by " r = E', �" "�` ='
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 of completion. Telephone Number: 704-634-5985.
Final installation Diagram:
System
Installed by -Diccmz-v
ro crrl`-
Certificate of Completion'' Date
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
n: 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.