674 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
�S-ewagee Treatment andDisposalRules (10 VCAC 10A .1934-.1968) Permit Number
Namb_Jamin D/. i%f�. iQBb� /PidVDate % ,9 L2 N2 0537
Location
Subdivision Name / Lot No. Sec. or Block No.
Lot Size Housey Mobile Home _ Business Speculation
No. Bedrooms`� No. Baths No. in Family
Garbage Disposal YES p NO ;moi Specifications for System:
Auto Dish Washer YESNO p Y/ r1
Auto Wash Machine YES] NO
Type Water Supply Go
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
1�
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..
Improvements permit y�
*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
L
qiCertificate of Completion kDate
*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.
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DAVIE COUNTY HEALTH DEPARTMENT
H IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'' ' r -NOTE:
issued in Compliance with G.S. of:North Carolina Chapter 130 Article 13c
Sewage Disposal Rules (10 NCAC/10A .1934-.1968)
Permit Number
Name
7Treatment'-and
�/, r" ^� //��i r�L'Date %v - rj �:
—.�._
", p_
/N_
O bJ
- Location
Subdivision Name ` Lot No. Sec. or Block No.
Lot Size House �Mobile Home _ Business Speculation .
No. Bedrooms --� No. Baths No. in Family QP�r �c:fJc
Garbage Disposal YES p NO Specifications for S stem:
Auto Dish Washer YES NO ❑ �������
Auto Wash Machine YES NO C]
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
1 ij
r
r .'
Improvements permit � y W"'?
*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:
J
System Installed by
Al I
Certificate of Completion Date
4-1 jf
-*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
`1
r
1 ij
r
r .'
Improvements permit � y W"'?
*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:
J
System Installed by
Al I
Certificate of Completion Date
4-1 jf
-*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