P3212 Martin Luther King Junior RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name? -SA-L Date .� – q ~43 N9 3212
Location ib –npe.11
Subdivision Name Lot No. Sec. or Block No.
Lot Size House. Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family,—
Garbage
amilyGarbage Disposal YES ❑ . NO ❑ Specifications for' System:
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES E]NO ❑ . S;nf– r`
Type Water Supply _
'This permit Void if sewage system described below is not installed within 36 months from date of issue.
a .
of
I
• � � �X 2 a l 2.i1�� /L�cK . .
Improvements ovements permit by
`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�����``d� '
Certificate of Completion Date -:✓ ���
.*The signing of this certificate shall indicate that the system describe above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be ken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name r. c ('�, , , �.- Date
'Location (',, o b:, r t � C..`- . Q c,A 'n"
t r' <<,_ r.•. �(� (c 5 c..!. —
1
Subdivision Name Lot No. Sec. or Block No.
Lot Size
No. Bedrooms
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
House
_ No. Baths
YES ❑ NO ❑
YES ❑ NO ❑
YES ❑ NO ❑
Mobile Home _ Business Speculation
No. in Family
Specifications for System:
i
C.ii i
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
!1
*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 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
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Name
Location
Subdivision Name
Permit Number
Date
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 ❑
Auto Wash Machine YES ❑ NO ❑
Type Water Supply _ f
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
*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
t f
Certificate of Completion f t, `!1 Date ' V-�
*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.