P2499 Daniel RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
COMPLETION
Name Date
Location
Permit Number
2
Subdivision Name Lot No. Sec. or Block No.
Lot Size /j ` Jf�, House i_� Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
YES ❑ NO ❑
YES ❑ NO ❑
YES ❑ NO ❑
i
*This permit Void if sewage system described
Specifications, for, System: 1
}� /1r"�.` �L a• .
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
I
i •,
t
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.
J
4 !
D VI% COMITY HEALTH DEPARTMENT
` Eth(IRO�iMENTAL HEALTH SECTION
MLLE, N.C. 27028
7 (7►). 634-5985
t.. '�• t'"a"'��a.: es.�''S+�- ,-'^fig :
5tatezaent .iota a tic TankI p dements. and/o Sit Eval tions
>: F 0-41 NAMEDATE
ADDRESS PERMIT 140.
__&:�-
EXPLANATION 9F` CHARGE
AMOUNT DUE SANITARIAN
"PLEASE REMIT THEI,'ABOVE A4OUNT ON RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluations) Bari- not be completed until payment is received.
Ingrovements Permit(s) can not be issued until payment(is received.