P3538 Sheffield Rd`
DAVIE COUNTY HEALTH DEPARTMENT
~ - . IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance 'With G.S,'of North Carolina Chapter 130 Article 13n
Sewage Treatment and Disposal 10A 1934 Permit Number
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mameu000 '
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Location
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Subdivision Name LotNo Se' urBlock No.
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Lot Size House __-__--_Mobile Home � Buoine�--_----_-Speou|aUon
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No. Bedrooms No. Baths - No�inFamily
______-_'
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Garbage Disposal
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Auto Dish VVaoher-
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Auto Wash Machine/CIO
YES
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Type Water Suppk/
*This permit Void if sewage oyotnn described below is not installed within 38 months from date of issue.
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Improvements permit �*Contact a representative of the Davie County Health Department foe 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.
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Final Installation Diagram:
Installed by
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'The signing of this certificate shall indicate that the system described
- has been installed" in comp|i- '�t.
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee thatthe system will function ' .
satisfactorily for any given period of time. /
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R : 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 �,�, l' ")."x, J, Date 3538
Location
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 Q- Specifications for System:
Auto Dish Washer YES ❑ NO ❑ , 1{.G�r ��
Auto Wash Machine YES] NO -❑ _
Type Water Supply
j
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by,__T'��?
"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;!�/'fir,
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.