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DAVIE COUNTY HEALTH DEPARTMENT
71,/ Y MAPROVEMENTS 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-. 968) Permit Number
Name z _'__'/ /J"O, Date i, 1/ , j- i �,"..., � fi ®
Location
Subdivision Name
Lot No
Sec. or Block No.
Lot Size �House Mobile Home Business Speculation
No. Bedrooms Nb.!Baths `� No. in Family `J
. ' 1,
Garbage Disposal YE$,'p NO E - Specifications for System:
Auto Dish Washer rGYES p NOp
Auto Wash Machine YES [h NO -p
Type .Water Supply
*This permit Void if sewage system -described below is not installed within .36 months from date of issue.
i�71 •.f j �,.
Improvements permit by
*Contact a representative of the Davie Counly He�\lth Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of compietion Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by
Certificate of Completion 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.