P5377 Hwy 801SDAVIE 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 DisposalRules 10 NCAC 10A .1934-.1968) Permit Number
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Name /XJi; i�� ('li..�'„o%' Date 1LL�?1J;=;(N2 5377
Location r f <�� �' ��/� � ��. a/U /! � -- SFJ,! ,civ -�,..� /��/PZ
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 ❑
Auto Dish Washer YES NO p
Auto Wash Machine YES NO [-]
Type Water Supply Ir '> %-
*This permit Void if sewage system described
Specifications for System:
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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 Installation Diagram:
System Installed by
W
r
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 as a guarantee that the system will function
satisfactorily for any given period of time..
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r 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� �i'f1�.-', ,%'FDate "'.. N 0 5 3 fr , 7
Location 'di'�'
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home �� Business Speculation
No. Bedrooms_ No. Baths g2 No. in Family
Garbage Disposal YES .fl NO ❑ Specifications for System:
Auto Dish Washer YES NO�1�� `
Auto Wash Machine YES U NO ❑�Q���
Type Water Supply
"This permit Void if sewage system described be
is not installed within 36 months from date of issue.
f'
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 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.
dl
{�
J
is not installed within 36 months from date of issue.
f'
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 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.