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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of. North,. Carolina Chapter 130 Article 13c
r -,.Sewage Treatmen and Disposal Rules (TQ NCAC 1.OA .1934-.1968) Permit Number
�'� N_ 53
Nam - � ' Date leg 0
Locatio '� �" ��/l•� ��✓ 116 .J o r /U/.
r
Subdivision Name Lot No. Sec. or Block No.
Lot Size Housey� Mobile Home _ Business Speculation
No. Bedrooms -- No. Baths No. in Family
Garbage Disposal YES p NO a Specifications for System:
Auto Dish Washer YES ❑ . NO p—
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.
I
rr,
_>veit/ -
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
�vV
Certificate of Completion Date :�222-3�
*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.
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4 DAVIE COUNTY HEALTH DEPARTMENT
� IMPROVEMENTS PERMIT'AND, CERTIFICATE OF COMPLETIONS
"NOTE: Issued in Compliance with G.S. of Nortla.Carolina Chapter 130 Article 13c ,
ew6ge'7featmen and Disposal -Rules (1, NCAC 10A .1934-.1968) - -----Permit Number
Nam ��/%/Date 819 %i
lJ
Locatio
Subdivision Name " Lot No. Sec. or Block No.
Lot Size House �� Mobile Home _ Business Speculation
No. Bedrooms �2 No. Baths No. in Family _
Garbage Disposal YES p NO a Specifications for System: r
Auto Dish Washer YES ❑ NO 8— v ii
Auto Wash Machine YES ❑ NO �`� ���(�?•'��'�/� 1
Type Water Supply
sy°
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
we
1
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
Certificate of Completion Date IZ22f�;'
*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.