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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
5� o�
nitary Sewa a Systems Permit Number
Name Date } D '� NO 6935
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size Q "_Z� House Mobile Home __ Business `- Speculation
No. Bedrooms No. Baths' No. in Family _
Garbage Disposal-", , YES ❑' NO
'- N
4., Specifications.,for System*
Auto Dish Washer YES NO `" 50 X -��i,j I►
Auto Wash Ma shine YE Sj NO ❑ `�`
Type Water Supply t ..
*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.
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�
Certificate of Completion \ C F� Date D
'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 shalljn NO way be taken as a guarantee that the system will function
satisfactorily for any given period'of time �^ `.
Subdivision Name Lot No. Sec. or Block No.
Lot Size Q "_Z� House Mobile Home __ Business `- Speculation
No. Bedrooms No. Baths' No. in Family _
Garbage Disposal-", , YES ❑' NO
'- N
4., Specifications.,for System*
Auto Dish Washer YES NO `" 50 X -��i,j I►
Auto Wash Ma shine YE Sj NO ❑ `�`
Type Water Supply t ..
*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.
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�
Certificate of Completion \ C F� Date D
'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 shalljn NO way be taken as a guarantee that the system will function
satisfactorily for any given period'of time �^ `.
Y r .�•M SS .xY y - ,. i i_'-Tvr-li iY{µ34y�.n.rr hu"..'T,�, aµ„r,r Y t! a1- rr''M.r.k •`i r Sw :1- _ i- - -\• r. - f 1. . -
�` VX0
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION �`yw
'NOTE: Issued incompliance With Article II of G.S. Chapter 130a
f Sanidar�i 3ewe Systs \ _ PerlmitrN�r
Name �,. Date NO tbj �y
Lo�ja
/ � F! L- - �r (L.) iJ �'�r.��s�-S'_...n �1 �.� cam.• .� �-ter � csr+- i
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 El/
, S ecifications for SXstemi,
Auto Dish Washer YES p, NO ❑ f
Auto Wash Ma .hine YES, ❑ NO ❑
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 reV ation if site plans or the intended use change.
�,J f
Ne.� N Q
— JZ0
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 —
• � ��� )� -a2 q2
Certificate of CompI etion 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: