P3171 Hwy 601SDAVIE 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 Date
t
Location f ji��f f./1-. ! j'fJllJz i%. i'% r>> r.;?Z.-% /7�-n/.'✓ !_�!v F/ __
Subdivision Name Lot No
Sec. or Block No.
Lot Size j`-}+ - House Mobile Home _ Business _— Speculation
No: Bedrooms -- % No. Baths _ No. in Family
Garbage Disposal YES ❑ NO ❑>
Specifications for System: P • ! -
Auto Dish Washer YES ❑ NO ❑ P10
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
'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
i
f
i
j
i
Certificate of Completion -- .1 Date
.i
"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.
DAVIE COUNTY HEALTH DEPARTMENT 04
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name 'Ll' Date
Location
Subdivision Name
Lot No.
Sec. or Block No.
Lot Size
House Mobile Home
_ Business __
Speculation
No. Bedrooms
No.
Baths 1 No. in Family
Garbage Disposal
YES
❑ NO ❑
S Specifications for stem:
p y
;..
�z Pf
Auto Dish Washer
YES
F-1NOE)
/000
Auto Wash Machine
YES
❑ NO i❑
,.
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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
J-> cyk'
Certificate of Completion ti's_\ ± t` Date i -
'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.