P2894 Hwy 64WDAVIE COUNTYHEAI�TH DEPARTMENT
PWIMPROVEMENTS PERMIT AND :CERTIFICATE OF COMPLETION
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
House
_ No. Baths
YES ❑ NO ❑
YES NO ❑
YES ❑ NO ❑
Lot No
Sec. or Block No.
Mobile Home _ Business Speculation
No. in Family
Specifications for System:i-
*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 11 1\ OUJ
Certificate of Completion ^z 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.'HEA6TH 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 I 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: -= 1 .»
Auto Dish Washer YES ❑ NO ❑ --
Auto Wash Machine YES ❑ NO ❑ t
Type Water Supply
"This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
U
'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
*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.