227 Calahaln Rd D"IE 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
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Name �Z�r ,� r7 � � ' Vu�t�WDate "� 2
Location �4 LA ( IZ Ln 4 A N '- f i+rz,y L z:it
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 Ej NO ��f��
Specifications for, System:.
Auto Dish Washer YES NO p y ,-
Auto Wash Machine YES NO p
Type Water Supply
F
*This permit Void if sewage system described below is not installed ithin 36 months from date of issue.
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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 byZ' rv�v�
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Certificate op
f Com letion Glr� Dat
*The signing of this certificate shall indicate that the system describ 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.