128 NaeNae LnDAVIE 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 Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business — Speculation
No. Bedrooms No. Baths f No. in Family
Garbage Disposal YES :E] NO 0- Specifications. for System:
Auto Dish Washer YES E] NO C]
Auto Wash Machine YES E] NO' ,E]".
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of %. issue.
0' 1
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
Certificate of Completion
*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
k, + r
_,Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date
..
Location ':',�-' �/ %iii %/ i//i .�: % j'- ',i%' ;�./ % s,� ✓, (�,
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home l''"� 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 p
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by /4,17 r
*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:
L
System Installed by�f
Certificate of Completion jri f i Du
te
*The'"signing of this certificate shall indicate that the system descried above has' been insta�,led 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. F
Stat(
NAME
ADDRESS
EXPLANW
DAVIE COMITY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P. 0. BOX 57
MOCKSVILLE, N.C. 27028-
(704) 634-5985
$t fors an90 Claluations
.�U'ic T4nk ?qprovements Permit
DATE
Or CHARGE
PBP14IT 140.
AMOUNT DUE SA14ITARIAN
N
LEASE REMIT THE, 2MOVE A! k\VUNT ON RECEIPT OF THIS STATEMENT.
\
*NOTICE: Evaluation(s) can not be completed until paynent is received.
Improvdments Perrat(s),can not be issued until payment is riSceived.
of Combl ai nant
°,caress_
Complaint
,1;VIF COUTY E'c ^.LTFa
Co` PUINT FOP"
' ate.
Persons `;esgonsible for Complaint
TelerhonQ
'1 ler'I s ' Vjv e a
Foad °o.
Referred to ��"!�� 'late
Action*
Gate '
Final Disposition
Signed
*Us,- Back If :eedee.