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P2099 Smith, DonaldDAVIE 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 �d/1�L /3t-� 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 YES :3--NO 0— Specifications for System: Auto Dish Washer YES E],- NO Auto Wash Machine YES p NO p ' 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 by (",/ L4 Certificate of Completion `'-�! Date .. frry � ' � r 'The signing of this certificate shall indicate that the system describZabove 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. DAVIE COUNTY HEALTH DEPARTMENT � P. 0. BOX 57 MOCKSVILLE, N. C. 27028 (704) 634-5985 Statement for Septic Tank Improvement Permits and/o Site-Evaj.uations NAME DATE ISSUED ADDRESS PERMIT N0. ©-42 Explanation, of charge J 1� z AMOUNT DUE `.�c SANITARIAN PLEASE REMIT THE ABOVE AMOUNT - ON RECEIPT OF THIS STATE ENT.