P2863DAVIE 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`- Date Y r'., ►`s
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size /r / =""
l House '`"� Mobile Home.
No. Bedrooms �_1'
No. Baths ��' No. in Family _
Garbage Disposal
YES ❑ NO ❑�
Auto Dish Washer
YES p NO ❑
Auto Wash Machine
YES p NO -❑
Type Water Supply
, ./, -/f'
Business Speculation
Specifications for System:
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
f
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:
r
*The signing of this certifii
the standards set forth in i
satisfactorily.for any given
System Installed b��
Y `,. .Y
Certificate of Completion Date �r
rte shall indicate that the system described above has been installed in compliance with
e above regulation, but shall in NO way be taken as a guarantee that the system will function
)eriod of time.
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