177 Lakewood DrEO 10 -ID
DAVIE COUNTY HEALTH DEPARTMENT v r�
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systems f��9c-�Bp Permit Number
Name ._ ,_ l� Date 10 NR 5848
Location `` • — -
Subdivision Name \ Lot No. / Sec. or Block No.
Lot Size House ✓ !Mobile Home _ Business Speculation
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No. Bedrooms No. Baths L— N0. in Family
Garbage Disposal,-, , YES . Q'y , NO C� . Specifications for, System j• N
Auto Dish Washer. YES P/ N0 -�❑
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Auto Wash Machine YES [p/NO ❑ � %( 3 X �a -i
Type Water Supply ---
*This permit Void if sewage system described beloWfis not installed within'5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
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Improvements permit b
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*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:
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System Installed by Foo ±"
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Certificate of ��F pletion �� Date / y
'The signing of this certificate shall indicate that the syst 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.
CO NTY HEALTH DEPARTMENT (/ �`
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`- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a ,cf t�v�
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Sanitary Sewage Systems permit Nmber
-- / N_ 5848Name " � Date 2 u U
Location. —
Subdivision Name Lot No. "J Sec. or Block No.
Lot Size-- House Mobile Home _ Business Speculation
No. Bedrooms No._Baths ,No. in Family
Garbage Disposal,,,.., YES ❑;. , NO M/ Specifications for System:,.
Auto Dish Washer YES p/NO ❑
Auto Wash Machine YES � NO E]l �
Type Water Supply ---
*This permit Void if sewage system described below'is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
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Improvements permit byC�''_`.v
*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
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Certificat of Icb� pletion 0 Date J `
"The signing of this certificate shall indicate that the syst m 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.