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s DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEN} N S PERMIT AND CERTIFICATE OF COMPLETION
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"NOTE:Issued in Compliance VNt A ;cle f Der 130a -Ac
,V
,� �' Permit ber
Name " ` ry!"���� �m Date �. .�/�� N2 lfg 4
32,1 �'
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 ❑ NODWTI,•/rd l
Auto Wash Ma shine YES p NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
ss
b
Aa
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
dU�
(J
Certificate of Completion �,✓ .� Date f 7—
"The
•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.
.tet.-::,_<,-.r :.. y. s.-. 1'.,'.l'f� .- Y -?.{: r . .ted'.. 'r' •it <. s.
,. DAVIE COUNTY HEALTH DEPARTMENT.
� ♦'i � y" d 1 •yam.. _.,
IMPROVEMENTS PERMIT AND 'CERTIFICATE OF COMPLETION
:. 'NOTE:Issued in Compliance Wft Article l of G.S Chapter 130a
anifary Se age Syst % d�`� 7�''''�' / Permit Number
.. Name ����IN/1 �Date ' Z �r .�/�r N2 6864
Location
Subdivision Name Lot`No. Sec. or Block No.
Lot Size House ��r 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 Ma thine YES�nl❑ NO ❑
Type Water Supply
4'
`This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
�ry FT—
t
Improvements permit by __ Aq
/
'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
ELI
Certificate of Completion 41 Date "-7— - +r-42-?
CT- 41 ,t-
'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.