1613 Davie Academy Rd 4F F
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- 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
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Location
Subdivision Name Sec. or Block No.
Lot Size /! %? House Mobile Home — Business Speculation
No. Bedrooms C� No. Baths No. in Family
Garbage Disposal YES Cl NO Specifications for System:
Auto Dish Washer YES p NO
Auto Wash Machine YES NO Q '
Type Water Supply /!i.-r/" _—
*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 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
sati$factorily for any given period of time.