P3878 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
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name q( c f Date —4 Z 3 - $ sr �D 3 0 78
Location (., o l l C 4 �7 4:. LV i'u a._ -12 a .
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 ❑ _ �'.( 3�x� 0
Auto Wash Machine YES ❑ NO C]
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
U' �( \
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
Nesse
Certificate of Completion `' v Date "2 G6a7'5�-
*The signing of this certificate shall indicate that the system describi 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
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" Al (e, LJ DatedNJ,2 3875
Location 14, 1%
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 ❑ 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
,�j
*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 T�
r
O
IL ^.7I
1
Certificate of CompletionC�rN`y V lA 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.