P3092 Redland Rd}
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 Date
Location --
i
Subdivision Name
Lot No
Sec. or Block No
Lot Size House Mobile Home Business Speculation
r
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.
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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
Certificate of Completion Date
*The signing of this certifi to shall indicatethat'the system described above has been installed in compliance with
the standards set forth ' 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
`"Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
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
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.
Permit Number
Name
Date P ` rw
Location
.T
Subdivision Name
Lot No. Sea ,or Block No.
Lot Size
House Mobile Home �-'Business Speculation
No. Bedrooms
No. Baths No. in Family r _
Garbage Disposal
YES ❑ NO ❑
Specifications for System:
Auto Dish Washer
YES ❑ „NO ❑
Auto Wash Machine
YES>❑ -NO
Type Water Supply
11
Y
*This permit Void if sewage system 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 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
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.
S
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dress �'D� // (l�� Telerhone
Complaint IV_ -
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Parsons Responsible e for Coral l ai nt
N%Aress
wetail "irections to Complaint
Referrc6 to
Acti on*
Final ^isaosition
*Use Back If .^eeded.
_Telephone
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Date
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