2211 Hwy 64W,. '-.: ��twa;. � >!♦ do r;. s5> � c +3 � }, s,'+�,
. � r rig. "7 .�� a �..r w.�d ♦k' f:3. , r , .. , ,' P vv/ ,
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND . CERTIFICATE OF COMPLETION
* NOTEAssued in Compliance With Article If of G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
Name 1 h �„ 7` ��r'i l� Date —7 -,2 - NO
,Q /� 6 67 9
Location. <f�
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 ❑ _ , A
Auto Wash Ma thine YES NO ❑ / X
Type Water Supply �o _
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change. // l
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:
Svstem 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
A" *NOTLIssued in Compliance With Article II of G.S. Chapter 130a
Sanitary :Sewage
jjSystems Permit Number
Date -?'`�� N2
Name _ n
7
Loc tion
X
Subdivision Name Lot No. Sec. or Block No.
Lot Size House 1/` Mobile Home _T Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal . YES ❑ NOSpecifications for System:
Auto Dish Washer YES 4 NO ❑ _ ��
Auto Wash Ma shine YES i NO ❑s X' '`+: %�
Type Water Supply
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change. _
I
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
Q
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.
I