145 Lakewood DrDAVIE COUNTY HEALTH DEPARTMENT
_i IMPROVEMENTS PERMIT AND CERTI ��FI C MPLETION
*NOTE: Issued in Compliance With Article 11 of G:S. Chapter 130a o2 ? ��f o �T S
ani Sewage Systems C/o
w� Permit Number
Name. 0.��� C P.Q.�C e� Date _ ND 5836
Subdivision Name LOT No. Sec. or tslock No.
Lot Size House �' Mobile Home _ Business __ Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal;r YES, ❑ NO p� Specifications for System:
Auto Dish Washer, ' YES ❑ NO
Auto Wash Machine `YES (12/'NO ❑ bb Y(
Type Water Supply
*This permit Void if sewage system described belowis 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 p r
it by
*Contact a representative of the Davie County Health Departm for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telepne Number: 704-634-5985.
Final Installation Diagram:
m Installed by
y
Certificate of Completion /r Date
P —
*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.
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'-VIE. COUNTY HEALTH DEPARTMENT'
IMPROVEMENTS PERMIT ~~ ..~ CERTIFICATE
- °NOTEIssued inCom�ia�a���d�aU����� r1�� �� '�� '
' Permit Number
Sanitary Sewage Systems^
Name C/' ' 16ate r�- N2 5836
Location
,
Subdivision Name - Lot No. sec. orBlock No.
Lot Size House Mobile Home____-_--- Business - Speculation
No. Bedrooms No Baths No in Family
. .`
Garbage Disposal: YES.[] NO 02/ Specifications for System:
Auto Dish Washer ' , YES NO nl/
Auto Wash Machine ^YES NO [� '
'
Tvoa 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 nnbbv
y
^Contaota representative of the Davie County Health Departmenrfor final inspection of this system between 8:30-
9:30 A.M. or 1�OO-1:3O P.M.on day of completion. Te|aphdheNul�bec7O4'G34'5S85�
` _
Final Installation Diagram
mInstalled by
C
/
,
Certificate of Completion OaUa
` .
*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
ued|afantori|yfor anygiven period of time.
. .
-
'
�
^
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`
/ /
-
� -
~
^�
Improvements nnbbv
y
^Contaota representative of the Davie County Health Departmenrfor final inspection of this system between 8:30-
9:30 A.M. or 1�OO-1:3O P.M.on day of completion. Te|aphdheNul�bec7O4'G34'5S85�
` _
Final Installation Diagram
mInstalled by
C
/
,
Certificate of Completion OaUa
` .
*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
ued|afantori|yfor anygiven period of time.
. .