P3042 Martin Luther King Junior RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued ir Compliance with G.S. of North Carolina Chapter 130 -Article 13c.
Permit Number
Name
Date
�. .
Location -
Subdivision Na a Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Dispo al YES ❑ NO ❑ Specifications for System:
Auto Dish Was er YES ❑ NO ❑ 5-B'A'
Auto Wash Machine YES ❑ NO-❑tPii��'
Type Water Supply _—
*This permit Vdid if sewage. -system described below is not installed. within 36 months from date of issue.
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. o 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
"S-e'
92,1
System Installed by
N.
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
satisfactorilj for any given period of time.
*Note: Issued in
Name.
Location
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
;ompliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
v - ; IF"I
Date t
.:a 1rA2t.ii i`.:
Subdivision Na
r)
Lot
Lot No
Sec. or Block No
Lot Size House Mobile Home _ ' Business ,Speculation
No. Bedrooms No. Baths No. in Family
Garbage Dispos I YES ❑ NO ❑ )., , ► Specifications for System:
Auto Dish Wash r YES ❑ NO ❑ 5a''
Auto Wash Machine YES ❑ NO ❑ 2eP��R
Type Water Supply
*This permit Vold if sewage system described below is not installed within 36 months from date of issue.
Improvements permit byii •��
*Contact a re resentative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. o 11:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by —
=V1
g 2'
Certificate of Completion Date
*The signin of this certificate shall indicate that the system described above has been installed in compliance with
the standa ds set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for anygiven period of time.