1578 County Home RdDAVIE 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 a O t (n1 171Z_��Ei�l �T, t bux l( Date g- �� �f' f e `� 5
tti��..� o� � t;
Locatiori
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 g- /l
Specifications for System:
Auto Dish Washer YESNO ❑ ` ./
Auto Wash Machine YES [�] NO ❑ �� Jc �. /Z
Type Water Supply (',,$)N
*This permit Void if sevyage sys)em described below is not installed within 36 months from date of issue.
Improvements permit by
*Contact a representative of the Davie County Health Department for final inspection vof 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 Insta
System Installed by
I_J
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 betaken 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
Sewage Treatment and Disposal Rules ,(10 NCAC 10A .1934-.1968) / Permit Number
Name Otln1 C71L£�tJ �7 ( 3"' y(/ Date g- �• a�, — 36%5
Location ! /Z ,/1' L;D c !C ��) a s r
Subdivision Name
Lot Size House
No. Bedrooms 3 No. Baths t
Garbage Disposal YES ❑ NO
Auto Dish Washer YES NO ❑
Auto Wash Machine YES ❑ NO -❑
Type Water Supply vj" T-`
This permit Void if
Lot No
Sec. or Block No.
Mobile Home _ Business __ Speculation
No. in Family 2 -
Specifications for System:
Improvements permit by
V
*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.
�1
Certificate of Completion Date �IIl _
'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.