P4487 Hwy 801Si'- DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION i
`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 /, 1 .� i ...-� �. Date
Location
Subdivision Name
Lot No.
Sec. or Block No
Lot Size a House Mobile Home _ Business Speculation
No. Bedrooms ? No. Baths __ No. in Family � _
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES NO
Auto Wash Machine YES NQ,, U.
Type Water Supply
"This permit Void if sewage system desr6ribed below is not installed within 36 months from date of issue
r;
Improvements permit by
*Contact a representative of the Davie Co 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 co le tion. Telephone Number: 704-634-5985.
Final Installation Diagram:
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System Installed by��`F-r`)
O I L
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Certificate of Completion_yj
*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.