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DAVIE COUNTY HEALTH DEPARTMENT6
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
NOTE:Issued in Compliance With Article II of G.S.,Chapter 130a
Sanitary
rSewage Systems r/a/ Permit Number
Name v i,l ' P _ –! 11L N2 6 3!-'D 7-
Location /';z/JV�
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 YES NO E] �1�X3,Y�� �
Type Water Supply �� ---
*This,permit Void if sewage system described below is not installed within 5 years from date of issue.
Thispermit is subject to revocation if site plans or the intended use change.
� d
Improvements permit by --
.rT� •
*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
Aid
Certificate of Completion c-7 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.
DAV'IE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND ,CERTIFICATE QF COMPLETION
` "NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a _
"= = Sanitary Sewage Systems / Permit Number
f' Name •.0 r �,i.rf7` ' c'5 ;.
Date N0
- , - 635
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House 4e!!:�: Mobile Home _ Business Speculation
No. Bedrooms .No. Baths sf No. in Family
Garbage Disposal YES ❑ NO 53--' Specifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Ma:hine YES NO ❑
Type .Water Supply - t11A --
*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.
P �
r
1
J -
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
loll
'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 a
satisfactorily for any given period of time.