P3877 Floyd MitchellDAVIE. COUNTY ,HEALTH DEPARTMENT
:.4 IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
NOTE: Issued in Compliance with G:S; of North Carolina `Chapter 130 Article 13c:
Sewage Treatmernt and Disposal Rules _(10 NCAC 1O .1934-.1968) PermitNUgmber
r Name 4���f tff t / Date < j; ` ✓ -T-� is
Ee
Location
Subdivision Name -Lot No. Sec. or Block No.
b Lot Size House. 47-- Mobile Home _ Business Speculation
f No. Bedrooms No. Baths _ __ No. in Family
Garbage Disposal YES ;❑ -NO '❑ Specifications for System:
t•
Auto Dish Washer YES ❑ NO ❑
i' Auto Wash- Machine YES [] 'NO
❑ ' r %=t;
,f
Type Water Supply
*Thispermit. Void if sewage system described below is not installed within 36 months from date of • issue.
!'` � .• ��_ Yom.....`=•";{j
f ✓� t
h 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
Certificate of Completion - --Date�y a
. ; *The, signing of.this certificate shall indicate that the system described above has been, installed in compliance°.with
a the standards-set,forth in:the above-regulation, but shall -in NO way be taken as a guarantee that_the system will functions
unction = -
satisfactorily for any given _period of time
c