P3533 Jeff Bowden2'30
DAVIE COUNTY HEALTH DEPARTMENT
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IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name Date 3533
Location
---T ,---�.-< - -
Subdivision Name Lot No. Sec. or Block No.
Lot Size House i/ Mobile Home _ Business Speculation
No. Bedrooms No. Baths - No. in. Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System: / v,
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ NO ',❑
Type Water- Supply
*This permit Void if sewage system described bqo is not insta*1i'ej 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
17
Certificate of Completion - e
'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
_ Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name—,( ',�1� :" Date/ 4;�&'J:�
�ti
Location
Subdivision Name
Lot Size
No. Bedrooms
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
Lot No.
Sec. or Block No
House Mobile Home _ Business Speculation
No. Baths No. in Family
YES ❑ NO ❑ Specifications for System:
YES ❑ NO ❑ P -
YES ❑ NO ❑ _ . � � �.� .'r'J
*This permit Void if sewage system
s not installed within 36 months from date of issue.
Improvements permit by :!r
r
*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
. Certificate of Completion ✓/ / fDafe __
*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.
STATEMENT
• DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
210 HOSPITAL STREET
P. 0. BOX 665
MOCKSVILLE, NORTH CAROLINA 27028
(704) 634-5985
DATE / C
Ned
� J
DETACH AND MAIL WITH YOUR CHECK. YOUR CANCELLED CHECK IS YOUR RECEIPT.