148 Cana Rd (2)DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION " P�'X3
NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage,Treatment and Disposal, Rules (10r NCAC 10A .1934-.1968) / Permit Number
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Name / %r„; f %j> / ,, % ' / ��� � Date�If
33YO
Location / �' _ >. `} r, re l i<.'' ~ /' "f�,/�'
Subdivision Name Lot No. Sec. or Block No.
Lot Size )it', House Mobile Home _ Business Speculation
No. Bedrooms —? No. Baths No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑ , ,-,
Auto Wash Machine YES ❑ NO ❑
Type Water Supply
*This permit Void if sewage system described below is 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
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r
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f/
ICA
Certificate of Completio Date L6
'The signing of this certificate shall indicate that the system descr' ed above has been installed in compliance with
the standards set forth in the above regulation, but shall in NO way a taken as a guarantee that the system will function
satisfactorily for any given period of time.
r~ ' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
.ti
w *NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c % \e
�. Sewage Treatment and Disposal' -Rules (10 NCAC 10A .1934-.1968) Permit Number
Name Date ,3 /`
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business _— Speculation
�, o.` Bedrooms No. Baths --, _ No. in Family —
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑ a
Auto Wash Machine YES ❑ NO ❑
Type Water Supply _.
'This permit Void if sewage system described below is 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
,t
3/
Certificate of Completionl_,_,Date
ri e
"The signing of this certificate shall indicate that the system descd 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.