P3717 Hwy 601N`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"' % Date
17
Location
/T ��f
—
Subdivision, Name Lot No. Sec. or Block No.
Lot Size T:% House Mobile Home — Business Speculation
No. Bedrooms t;:�— 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
*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 Cod► ealth Departmen or final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Nu ber: 704-634-5985.
Final Installation Diagram:
System Inst4lled by
Certificate of Completion _ ��i7 x 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.
.t
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
�- ,r-�„/
Name ) Date –/i �j`3717
Location �� .%' /� % /�' E. '�/ .•�� s �� �.��
Subdivision Name Lot No. Sec. or Block No.
Lot Size's House _ "Mobile Home Business Speculation
No. Bedrooms c27 No. Baths Z No. in Family —f5-2 —
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 Ttalled within 36 months from date of issue.
r
7
Improvements permit by
*Contact a representative of the Davie C yHealth Department or final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Nu ber: 704-634-5985.
Final Installation Diagram: System Inst Iled by -X
Certificate of Completion _LILT/�/Q�_ D
*The signing of this certificate shall indicate that the system described above has been installed in co pliance 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.