541 Merrells Lake RdDAVIE COUNTY HEALTH- DEPARTMENT
.IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
5 *NOT I sued in Compliance with G.S. of North Carolina Chapter 130 Article 13c�%��'
ewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Names `r�L f /��': iS;/y Date r— a :;% <.rt �� r 4
it
Location . �,.! - i ,�>>, �y . {,,,� �,� ;•,. ;;.
%� . - �` s;t, fi✓ "'-. i� - •"�f :•.fes , — r,3___,.I'%G'
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 F1 NO [--
Specifications for System:
Auto Dish Washer YESNO
Auto Wash Machine YES mp
NO
Type Water Supply
*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 Heal h Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completio . Telephone Number: 704-634-5985.
Final Installation Diagram:
\v 1
Installed by 1/ 0'r 111'-f .,
Certificate of Completion sf `2'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.