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DAVIE COUNTY HEALTH DEPARTMENT._.____
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Date—Z'"�--r �147><
Permit Number
N2 7cil A
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business -- Industry
No. Bedrooms 1Q, No. Baths 4-� No. in Family — Public Assembly Other
Garbage Disposal YESr6 NO
Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Ma shine YES ❑ NO Y'
Type Water Supply_el
*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.
L�
F
Improvements permit bY--AXA
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
./,A17 /,0,/
Certificate of Completion 74[4a/� 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.