P2678DAVIE 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 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 ❑ 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.
i
i
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:
ed by f-_ t -r/`
Certificate of Completion Date
'The signing of this certificate shall indicate that the system described aboh been installed in compliance with
the standards set forth in the above regulation, but shall in NO way be taken s 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 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 E] NO E] 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:
Z I <---
tailed by
I
Certificate of Completion r F
Date
*The signing of this certificate shall indicate that the system described above'haslleen installed in compliance - with
the standards set forth in the above regulation, but shall in NO way be taken,6s a guarantee that the system will funi6tion
satisfactorily for any given period of time.
i.
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:
Z I <---
tailed by
I
Certificate of Completion r F
Date
*The signing of this certificate shall indicate that the system described above'haslleen installed in compliance - with
the standards set forth in the above regulation, but shall in NO way be taken,6s a guarantee that the system will funi6tion
satisfactorily for any given period of time.