P2252 CooleemeeJ -D
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 % 1. 1G:� ! ori(« - Date6'2
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 E] NO Q'
Specifications for System:
Auto Dish Washer
YES p NO i]�
i, c _ ; ,
,; ,T�l;,. , r�. 1;. , • .
Auto Wash Machine
YES NO
Type Water Supply
1
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit by
v
*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: Sy tem Installed by To,
SLA
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Certificate of Completion �1, lr,.�'', Date I
*The signing of this certificate shall indicate that the system described 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.
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 I i l lG �,ha % �'� Date 71,� ;a
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths r No. in Family
Garbage Disposal YES ❑ NO ❑ 1
— - j- { -
Specifications for System, 1 ' "'
Auto Dish Washer YES ❑ NO t �� k. t i e_ - w,,<:1;,,, n-,,1 r
Auto Wash Machine YES NO ❑ -� C
Type Water Supply
'This permit Void if sewage system described below is not installed within 36 months from date of issue.
l'
Improvements permit by r-:
v
*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:
Installed by ?RL')
10L'Atk
�I 9'j 717
Certificate of Completion - `M al- J0 Date
'The signing of this certificate shall indicate that the system described 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.