P2115DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Name
Location
Date
Permit Number
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 __—
*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
Certif
"The signing of this certificate shall indicate tf
the standards set forth in the above regulation,
satisfactorily for any given period of time.
of Completion Date a,. -
the ystem described above has been installed in compliance with
t sh II in NO way be taken as a guarantee that the system will function
DAVIE COUNTY HEALTH DEPARTMENT
� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
^ `<`
°Note: |aound in Compliance with G.S. of North Carolina Chapter 130—Article 13c. ~`
Permit Number
/. ��'- `` �.' �
Name ' - ' - ' Date
Location
'
'
Subdivision Name Lot No. Sec. orBlock No.
Lot Size House— Mobile Home _— Business ____ Speculation
_��
No. Bedrooms ___'
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
- No. Baths — No. in Family
YEGO NO E]
YES [] NOF -1
YES O NO[]
Specifications for System: -
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
/
I
°Con1oota representative of the Davin County Hno|Mh 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: 7U4'G34'5985.
Final Installation Diagram: System Installed by
/
Certificate of,Completion Date/
'
'
*The signing of this certificate shall indicate tsystemhatithehas been installed in compliance with
the standards set forth in the above regulation, b0t sh�ll in NO way be taken as a guarantee that the system will function