P3607 Hwy 64WDAVIE 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 / ,:�� F. lJ %: iii Date d 'N9 3607
Location
Subdivision Name
Lot No. s_ Sec. or Block No.
s
Lot Size 41(/1
House �� Mobile Home _ Business
Speculation
No. Bedrooms
No. Baths
No. in Family
Garbage Disposal
YES p NO -p-''
Specifications for System:.
Auto Dish Washer
YES [] NO�J
`9=
Auto Wash Machine
YES [] NO p
Type Water Supply_—
`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 I
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.
rz:aX _ 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 ,' ,r, % f,r jr Date �' 3i€:
Location •. �_, .•/r,' �:r % ,-.,.;--" _
Subdivision Name Lot No. Sec. or Block No.
Lot Size r� % House Mobile Home _ Business __ Speculation
No. Bedrooms No. Baths No. in Family _
Garbage Disposal YES ❑ NO ;p'
Specifications for System; t r;
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
*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 I
Certificate of Completion W,<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.