P2945 Hwy 801NDAVIE COUNTY HEALTH- 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 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 ❑ ,%'=
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.
t1�
V
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�C�'!y«/
Certificate of Completi n
''The signing of this certificate shall indicate that the systemsi
the standards set forth in the above regulation, but shall in NO a'
satisfactorily for any given period of time.
Date ( b
�d above has been installed in compliance with
taken as a guarantee that the system will function
*Note: Issued i
Name
Location
Subdivision Na
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND -CERTIFICATE OF COMPLETION
Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Date _t:0
Lot No
Sec. or Block No.
Lot Size House Mobile Home — Business Speculation
No. Bedrooms 7 No. Baths No. in Family
Garbage Dispos I YES ❑ NO ❑ Specifications for System:
Auto Dish Wash r YES ❑ NO ❑ �–
Auto Wash Mac ine YES F]NO F-1-
Type Water Su ply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
i 4
Improvements permit by
*Contact a repr sentative 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 Installatiod Diagram:
'The signing of
the standards s
satisfactorily fo
System Installed by
;`.c% X
Certificate of Completion1�� Date
his certificate shall indicate that the system described above has been installed in compliance with
t forth in the above regulation, but shall in NO Zvay betaken as a guarantee that the system will function
any given period of time.