2184 Cornatzer RdDAVIE COUNTY HEALTH DEPARTMENT
.IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued ir Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name `� _ , _ .' i / Date
w.
Location ' ,:; �,'_ .• / r'
Subdivision Nai
Lot No. Sec. or Block No.
Improvements permit by --
*Contact a rep esentative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A. M. or :00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. .
Final Installation Diagram:
*The signing c
the standards
satisfactorily 1
System Installed b�5'rFJ
it LL
Certificate of Completions --'i`Z-r---- Date
I
f this certificate shall indicate that the system described above has been installed in compliance with
set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
Dr any given period of time.
`
Lot Size
House
Mobile Home
_ Business Speculation
No. Bedrooms
_
No. Baths
No. in Family_-
Garbage Dispo
Auto Dish Wash
al
r
YES ❑ NO--'
O�
YES E] NO
❑ t
KZ
Specifications for System:
Auto Wash Machine
YES p�NO
E:]
i
Type Water Supply
*This permit Vo
d if sewage
V
system described below is not installed within 36 months from date of issue.
Improvements permit by --
*Contact a rep esentative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A. M. or :00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. .
Final Installation Diagram:
*The signing c
the standards
satisfactorily 1
System Installed b�5'rFJ
it LL
Certificate of Completions --'i`Z-r---- Date
I
f this certificate shall indicate that the system described above has been installed in compliance with
set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
Dr 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.
Permit Number
Name Date * r...
Location
Subdivision
Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. BedroomsNa. Baths No. in Family
Garbage Dispos I YES ❑ NO O Specifications for System:
Auto Dish Wash r YES F] IN. O p r
Auto Wash Mac ine YES ❑ ` NO ❑
Type Water Supply _—
*This permit Vo d if sewage system described below is not installed within 36 months from date of issue.
*Contact a reresentative 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'o &"iii ZY'-(1—
QLD LIrJi,
/1
j.WX3X.�g
Certificate of Completion Date
'The signing of this certificate shall indicate that the system descri d above has been installed in compliance with
the standaras set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorN for any given period of time.