300 Martin Luther King Junior Rd (2). "iW'i7-.w r+._.�...r--. y�.iats'�+u ..:riY'v yen_. Yr'.'a.v+:•..F.:-v,.Y..+:�:-P .. .Y. tY�.E
' DAVIE COUNTY HEALTH DEPARTMENT
-- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules.(10-NCAC 10A .1934-.1968) Permit Number
Name l f ar�N w1 fi�/Y�i �L�J�� Date
Location / ��A,`� v % . %
r
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 fl' Specifications for System:
Auto Dish Washer YES NO .Q
//
Auto Wash Machine YES NO F-1
/^O a
Type Water Supply __—
*This permit Void if sewage syst m described below is no 'nstalled within 36 months from date of issue.
�0 X10
�I-07 Q�g
Improvements permit by ,! �'-
*Contact a representative of the Dhyid County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on da of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by _
Certificate of Completion _ Date Zi
44�—
*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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E DAVIE COUNTY HEALTH DEPARTMENT —=� .,j-
�� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION r -"
""NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
- _ Sewage Treatment and Disposal. Rules (10 NCAC 10A .1934-.1968) Permit Number
Name ° i , 1 f,�l�� i-��� T �:L% L'4- Date —11 r"h"7 R` r, L ? -
/ . civ' Lr. M- _
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business _— Speculation
No. Bedrooms —:S�_ No. Baths __ No. in Family
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES NO ❑ ,�
Auto Wash Machine YES NO ❑ `� G''� ���y,, �'~`�
— >
Type .Water Supply _ � "- �f 1 __ /01 X ,
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
i
IT
{ li
Improvements permit by
'Contact a representative of the D vielCounty Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on d yjof completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by r
Certificate of Completion _.rte 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.