P6775 Gladston Rd A. Ka"hA
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
*NOTEAssued in Compliance With Article I I g�GAS Chapter 130
Spitary.Sewage S st/ems 6��t/��° �� Permit Number
Name pate' NO
67�5-
Location v
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 C],-- Specifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Ma.hine YES [�j NO ❑ �� Xv x�2,,
Type Water Supply 00 __—
*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.
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F
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
V4
Certificate of Completion _��/i'� Date �Ag71
"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. f
- DAVIE COUNTY HEALTH DEPARTMENT V
,. IMPROVEMENTS PERMIT AND .,CERTIFICATE OF COMPLETION
r'"NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
-SanitarySewage SS terns r E`J����ld-'ry �' Permit Numbed
Name '�,.�i�r ,�,�/ /,Date �T`' — ' k7 N 0
5677�--
Location `s �rwf!/�/ r' �,,�� ;L-�i f 2 i ✓err
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 Ma shine YES ❑r NO ❑ Md
Type_Water Supply o -
`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.
1 �
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
j
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.