P5966 Cornatzer Rd DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name G` U.h i�t" Date -.13 ND` 5966
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Location
Subdivision Name / Lot No. Sec. or Block No.
Lot.Size Housey Mobile Home'_ Business Speculation
No. Bedrooms No. Baths — No. in Family
Garbage Disposal YES p NO p- Specifications for System:
Auto Dish Washer YES ❑ NO ,per
U/ J�
Auto Wash Machine YES p NO
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.
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Improvements permit by �/—,2
*Contact a representative of the Davie County Health Di5partment 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
`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
Kms" IMPROVEMENTS PERMIT AND. CERTIFICATE OF COMPLETION
*.NOTE Issued in Compliance With Article I I of G.S.Chapter 139a`
Sanitary Sewage Systems r .cam Permit Number
Name _ i/.S-A7 L,01,41, r�! �` Date N2 5966
Location /-��.�" .�f r :��_.- �✓ l�t-L/
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No. Bedrooms — No. Baths No. in Family ra
Garbage Disposal YES ❑ NO 0' Specifications for System:
Auto Dish Washer YES ❑ NO
x Auto+Wash Machine YES ❑ NO [-
Type Water Supply i��_ ---
*This permit Void if sewage„system described below is not installed within 5 ears from date of issue.
This permit is subject to revocation if site plans or the intended use change.
r
141
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Im rovements permit b
P Y 12
`Contact a representative of the Davie County Health�De"a Ment 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
"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.