234 Indian Hills Rd ...... - w+r:..WY'M 1. .1+-..,y. ,... .+• ,.u ..r. . +�._ ..i ..._.. ... ,... .._..... .-. .,....._.. r _ _
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� -0 DAVIE COUNTY HEALTH DEPARTMENT f
IMPROVEMENTS PERMIT--AND CERTIFICATE OF COMPLETION
"NOTE: Issded in Compliance with G.S.of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name r' 'r :,.�' ,; ���.� � ;�/]% Date `''�=r ' �'" � ,°
Location
r .
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms c-V No. Baths `� No. in Family
Garbage Disposal YES p NO pi Specifications for System:,,
Auto Dish Washer YES . NO
Auto Wash Machine YES [j] NO
Type Water Supply _--
r
*This permit Void if sewage system described below is not installed within 36 months from date-of issue.
)5=
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 Dor'w� e V�AkQ�,I
tY /
e
r
Certificate pletion Date
'The signing of this certificate shall in icate that the s tem described above has been installed in compliance with
the standards set forth in the above regulatiolh.;but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time. C
.. '.s .J•t-.t,:r-sir.. �y.�, , .. ;t +/5..._'J.',:: ..x n.;..ir- ..'4M_: +. '.\ r F:: :'1'-t�;s � w�.ti �.:.:�- ,
DAVIE COUNTY HEALT)I4 DEPARTMENT
IMPROVEMENTS PERMIT�AND CERTIFICATE OF COMPLETION
J ,
*NOTE: Issues( in Compliance with G.S. of North-Carolina Chapter 130 Article 13c j
Sewage Treatment and Disposal Rules (10 NCAC 10A :1934-.1968) Permit Number
Name Date
Location �` T r. i%r ✓ �` /_. -ZL ..
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _%�'� Business Speculation
No. Bedrooms g2 — No. Baths _: 2 _ No. in Family _
Garbage Disposal YES Q NO 0'r
Specifications for System: ,
Auto Dish Washer YES X10
Auto Wash Machine YES j N0 ❑
Type Water Supply ( '
`This permit Void if sewage system described below is not installed within 36 months from date-of issue.
� •,�, '1J r'L�� J
1
/
_-2
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.
1
Final Installation Diagram: System Installed by
Certificate.Q,;Qar5pletion 9, Date
"The signing of this certificate shall in�ioate that the stem described above has been installed in compliance with
the standards set forth in the above regulatiof',but shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time. C