828 Hwy 801NDAVIE 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_�� i'� C c t� Vii'%��,^ .' — Date
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
Auto Dish Washer
Auto Wash Machine
Type Water Supply
YES C] NO ❑
YES ❑ NO ❑
YES ❑ NO ❑
Specifications for System: {
�t /,f �f � i / � tom'_ •� i � rJ h/ .� � ��
*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:
illed by
,17
11� I
Certificate of Comp
letion k), Date
—
X
*The signing of this certificate shall indicate that the system described above has been installed in 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.
3
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 �, • r c `�. %. Date y<'
/ ?>s.
Location ' , r:' r'"� f, JX.
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 ❑ NO ❑
Auto Wash Machine YES ❑ NO -❑
Type Water Supply_ ��, � f %',; — • ' r. � ;� _�_
*This permit Void if sewage system described below is not installed within 36 months from date of issue. .
1 ►
Improvements permit -by ---
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
a•Qn o nn ^r 1 -M -1-W) D h ^n rfw of rmmnlofinn Talnnhnna Nh imhar Ind-Rad-.gAR.q
n
Certificate of Completio Date
'The signing of this certificate shall indicate that the system described abov has been installed iAborkpliance 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.