P2954 Fork Bixby Rd DAVI E COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name - - Date c
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 E],-- Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES p NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
i
i
Improvements permit by
*Contact a representative of the Davie County Health Departm nt f fiffal inspection of this system between 8:30-.
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Tber: 704-634-5985.
r
Final Installation Diagram: System Inst Iled by
-
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.
DAVIE COUNTY HEALTH DEPARTMENT
~u IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths%�� No. in Family t%
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES M NO ❑
Auto Wash Machine YES F NO ❑ {�/
Type Water Supply ! _ -
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
*Contact a representative of the Davie County Health Depart{{ppgni:foyfinal inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of complete-16, rhe_ u6iber: 704-634-5985. �7 n
Final Installation Diagram: System Installed by
9 - , u
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.