P3667 R Shore DrDAVIE 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 S t trc. DFiZS Date 9 ` � _ ,�7` . SN-. -.3 I-
Location U / �✓ LEf -t �,14.r =A c
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 Ej NO 0� stem: Specifications for S
Auto Dish Washer YES NO S p y /) 0 O
Auto Wash Machine YES NO p 2w Xr
X' t
Type Water Supply U►- -r°. __ - %�
"This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit b&���`�
`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 03
NL SAN � yc 2
Certificate of Completio Date
"The signing of this certificate shall indicate that the system describ d 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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