P5935 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT
OIMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
nitary Sewage Systems t, Permit Number
Name f f ✓� r'/f� ICAs Date °1L�q_�" %n N2 5935
Locatio
Subdivision Name ' 1 Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms_ No. Baths.No. in Family
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO p-"
Auto Wash Machine YES ❑ ' NO
[�'� ���X �X,� 41
Type Water Supply
*This permit Void if sewage syste described below is not installed within 5 years from date of issue.
This permit is subject to revocatio if site flans or the intended use change.
�a
FAM
Improvements permit by _A1
*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 Y/—Z� 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.
DAVIE COUNTY HEALTH DEPARTMENT
VIMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
_*NOTE; Issued in Compliance With Article II of G.S. Chapter 130a
",r' nitary Sewage Systems Permit Number ,
NameT?1�ks bate. 2E - � �� N2 5935
Location
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 2-" Specifications for System:
Auto Dish Washer YES ❑ NO p'"
Auto Wash Machine YES ❑ NO
Type Water Supply ---
*This permit Void if sewage syste described below is not installed within 5 years from date of issue.
This permit is subject to revocatio if site plans or the intended use change.
t
i
td -
i
Improvements permit by Ito�l
"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 byA
Certificate of Completion L 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.