P2359 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.
Permit Number
Name_:,.r' .'�.� .' r : �:. i ;�`� -- Date
Location 01
Subdivision Name
Lot Size
House
No. Bedrooms , No. Baths
Garbage Disposal
YES ❑
Auto Dish Washer
YES p
Auto Wash Machine
YES p
Type Water Supply.
NO
NO ❑
NO ❑
Lot No
Sec. or Block No.
Mobile Home -� Business Speculation
No. in Family /
Specifications for System:
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*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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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.
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Final Installation Diagram:
System Installed by
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1
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Certificate of ComP letior' Ivi / Date
'The signing of this certificate shall indicate that the system describe�•1 y 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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