P2493 Myers RdDAVIE COUNTY HEALTH DEPARTMENT 4 --
IMPROVEMENTS
-IMPROVEMENTS PERMIT AND -CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name�.�l� �1„,, „� r lr<< S , r: -,L `I Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size ti %f T, ; House Mobile Home _ � -- Business Speculation
No. Bedrooms a No. Baths 1 No. in Family
Garbage Disposal YES :❑ NO g Specifications for System: goo cy-t
Auto Dish Washer YES ❑ NO [V _
Auto Wash Machine YES NO ❑ '? - �I x ' ' x',,�IC
Type Water Supply , i v- I __
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
N
permit by ^' r1 Irl A_ (t1\
*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 compl tion. Telephone Number: 704-634-5985.
Final Installation Diagra j
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Certificate of Completion�w"� Date .
*The signing of this certificate shall indicate that the system desbove 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. I