4314 Hwy 64EDAVIE 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 -9 2, SALy% c3�,n�� rn rT rase Date I )6 i5 N? 2257
Location (o v,4,it n, Qf-cias ' Vla S�� t� S-ia� �-- a
04
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
_ No. Baths No. in Family.
YES ❑ NO
YES ❑ NO C❑
YES ❑ NO ❑
Specifications for System:
/.5-6 5'3 "A- 2, (e /rte
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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F1. x/27
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 Instal led.by �Jdliv►,��
Certificate of Completion Date
*The signing of this certificate shall indicate thatthe 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
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number _
Name r 1 I , : 1 t' ;� Date
Location ;iC i } i )F l \ i < t 9✓r^7_� Ir. ( �r
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.
C Ji
1
`_ Wit. �`:_^�' �.1r
�// �.� J u^f(i.i•'��
y
C/ .
r
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:
i�
r.
System Installed by
Certificate of Completion 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.
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 Date
Location
Subdivision Name
Lot Size
No. Bedrooms
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
Lot No
Sec. or Block No.
House Mobile Home — Business Speculation
_ No. Baths No. in Family _
YES ❑ NO ❑ Specifications for System:
YES ❑ NO '❑ r..r/"
YES ❑ NO �❑ ;' %^ ,y� ..'✓
'`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:
j
f.
System Installed by
Certificate of Completion _ 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.
�1
f.
System Installed by
Certificate of Completion _ 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.