111 Cope Rd (3)\4+7L'ia::.F .i, .yy �, �,..il`?d.+�(. Jdy...'S✓'..i'. 14/y, t � ,. i Y( i ._ f � r� � M'1
9�
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article.l. I of G.S. Chapter 130a
Sanitary Sewage Syste s Permit Number
Date ,Ak �- ? NO 7 0,2 0
Location
&1A
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _T Business _— Speculation
No. Bedrooms �-� No. Baths 9— No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma shine YES ❑ NO ❑ ��� . �� .�
Type Water Supply
{
*This permit Void if sewage system described below is pdt installed within 5 years from date of issue.
This permit is subject to revocation if site plans oL_intend
d use change.
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 704-634-599885.
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.
Vx
O ,
r
DAVIE COUNTY HEALTH DEPARTMENT
�r AMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage S st s ,,/ �/� Permit Number
Fl GSC' a(j�� t' '/ Date �� � � z.o-. NO 7020
Name 2
Location X-0 O
Subdivision Name Lot No. Sec. or Block No.
Lot Size House L� Mobile Home _T Business __ Speculation
No. Bedrooms �-No. Baths a No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto :Dish Washer YES ❑ NO ❑
Auto Wash Ma shine YES ❑ NO ❑ j7 a ? v f `
Type Water Supply
*This permit Void if sewage system described below is t installed within 5 years from date of issue.
This permit is subject to revocation if site plans or t intended use change.
14.0 ..
r
l=
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
'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.