P4492 Hwy 801S�eo�1�07 DAVIECOU NTY HEALTH DEPARTMENT
-MOVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
i
*NOTs8 ed ni Compliance with G.S. of North Carolina Chapter 130 Article 13c
` Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit . Number
Name -; i/, �' l' Date c.J = 'F1. 1. r-0,2
- i .... ..
Location L
. , ✓ /; > ,i .-, , j r,- ` j , -�' �"
e%V
Subdivision Name
Lot Size
No. Bedrooms / No
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
Lot No
House Mobile Home _ Business
Baths No. in Family__
YES ❑ NO B—
YES NO ❑
YES NO ❑
Sec. or Block No.
Specifications for System: -
Speculation
*This permit Void if`sewage system described below is not in fp)lie�withi A months from date of issue.
I*
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.