P4183 Bobby Wall..,.r.'.. . ,... ..'w nf.. '::,.•.n .....- 1 -'.w ..w a , y a -. � ' n H - , I, r .. —
V
DAVIE COUNTY HEALTH DEPARTMENT
k,
IMPROVEMENTS PERMIT. AND CERTIFICATE OF COMPLETION
/*TOTE: 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
111 Name%��� 1`/%�%� -/i% ;� j / -/r`. Date �ii�' /��'% ` ht t
— - r-= �--- s .
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 ❑ N0 ❑ ✓L� %� /�%S/ / 4 �f
Type Water Supply _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
C 7 —
+l
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:
System Installed by�_. `_'�'"—�� -r
Certificate of Completion
e2'-/ Date
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.
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
C 7 —
+l
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:
System Installed by�_. `_'�'"—�� -r
Certificate of Completion
e2'-/ Date
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.
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�_. `_'�'"—�� -r
Certificate of Completion
e2'-/ Date
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.
STATEMENT
---� DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
210 HOSPITAL STREET
P. 0. BOX 665
MOCKSVILLE, NORTH CAROLINA 27028
(704) 634-5985
DATE -9/�,?/�'�C
F
k�j VtL CIO If
L I
DETACH AND MAIL WITH YOUR CHECK. YOUR CANCELLED CHECK IS YOUR RECEIPT.