829 Hwy 64W' DAVIE 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.tea! S11304
'� Dates /" i R;
It I
Location,C�%- 'Alp- ,yz/,�
t ) Ile
�~
— Z%' --
Subdivision Name
Lot No
Sec. or Block No.
.Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths —,oC— No. in Family �—
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES ❑ NO
Type Water Supply ICA,,__—
"This permit Void if sewagd system described below is not installed within 36 months from date.of issue.
*Contact a representative of the Dav Coun, �r
9:30`A:M. or 1:00-1:30 P.M. on day of comp
.n. Final'`Installation Diagram:
pg d r}
i
'�1777-
t
*The signing of this certificate shall ?imel
'cate ti-
the standards set forth in the above ul tion,
satisfactorily for any given period of
Improvements permit by
,althlDepartment for final inspection of this system between 8:30 -
[ion., Telephone Number: 704-634-5985.
System Installed by
e of Completion Date ��4
the system described above has been installed in compliance with
t shall in NO way be taken as a guarantee that the system will function
•,? DAVIE 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 T r t" 5 Date r!' ? i d
Location .�''� � ..!'� �.-, .� '�� ,%�._; ,, � /,,� �••;,
Subdivision Name Lot No. Sec. or Block No.
Lot Size House --''�� Mobile Home _ Business Speculation
T No. Bedrooms No. Baths _,�_ No. in Family Z
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO , , , i ��
•�l 'ice r
Auto Wash Machine YES ❑ NO
Type Water Supply
*This permit Void if sewage'
I
system described below is not installed within 36 months from date of issue.
Improvements permit by —� >
`Contact a representative of the Dav1 CounHealth'"Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M.' on day\of comfetion. Telephone Number. 704-634-5985.
Final Installation Diagram:
System Installed by
�e�ific�/e of Completion = f!` 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 re6ulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.