P3996 Will Boone Rdr 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-.1:968) Permit Number
Name ice, i 9/ Date b 3996
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 ❑ Specifications for System:
Auto Dish Washer YES ❑ NOof
❑ / r 1 — ' .
Auto Wash Machine YES ❑ NO ❑ i
Type Water Supplyr,:-=
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
:x
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:
System Installed by
Certificate of Completion
'The signing of this certificate shall indicate that the system described above has be
the standards set forth in the above regulation, but shall in NO way be taken as a guara
satisfactorily for any given period of time.
Date �f
en installed in compliance with
ntee that the system will function
177
�y'•� i
f
j�
13t
:x
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:
System Installed by
Certificate of Completion
'The signing of this certificate shall indicate that the system described above has be
the standards set forth in the above regulation, but shall in NO way be taken as a guara
satisfactorily for any given period of time.
Date �f
en installed in compliance with
ntee that the system will function
177