271 Buck Seaford Rd - .. , .' '• s X71 :t�, ,., k r ,. ,..}` ..
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT.AND .CERTIFICATE OF COMPLETION
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*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name Date 3 y N2 S302.
Subdivision Name Lot No. Sec. or Block No.
Lot Size `1 House ✓ Mobile Home —T Business Speculation
No. Bedrooms - No. Baths j No. in Family _
Garbage Disposal YES.❑ NO p' '
„Specifications for:,System::
Auto Dish Washer YES ❑ NO ,p%:
Auto Wash Ma shine YES Tr NO ❑ �'Q` 3 v �r 1�
Type Water Supply4z- � Sn�-
*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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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
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Certificate of Completion �- Date �_S
'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
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*I4OTE:*Issu0 in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems _ Permit
Number
Name 7'��*_, � ..t,r� ._�.�\ Date �� - N2 6302,
Location + Q� �, 1 .5 ��
Subdivision Name Lot No. Sec. or Block No.
Lot Size House w Mobile Home _� Business Speculation
No. Bedrooms No. Baths — No: in Family _
Garbage Disposal YES ❑ NO M,' = Specifications for System;
Auto Dish Washer. YES ❑ NO 0-
Auto Wash Ma:hine YES ❑- NO ❑ 5 0'
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. 1 ,amu
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Improvementspermit 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 (N k.
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t
y
Certificate of Completion Date -S
'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.