P2100 Milling Rd�t 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 �,1 �� ��� Y�c S -- - - Date f i - c� r' :�. U
Location
Subdivision Name
Lot Size
House
No. Bedrooms No. Baths
Garbage Disposal YES ❑ NO ❑
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ NO -❑
Type Water Supply
Lot No.
Sec. or Block No. --
Mobile Home _ Business Speculation
No. in Family
Specifications for System:
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by ��` � ►�<<� ��1,I\JA
*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 vi
Certificate of Completion `A�"� ' • Date \A
*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 taker' 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 -= +,11 \�� �,. � , c - - Date l � i 21.00
Location
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 ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ NO •❑
Type Water Supply _
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
�I' c
t
If-, f &,""' ",
J1 u�c�
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:
A
al
lf
System Installed by zs
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.