P5893 Jericho Church Rd a
�"o DAVIE COUNTY HEALTH DEPARTMENT
_
IMPROVEMENTS ,PERMIT AND CERTIFICATE OF COMPLETION
*,*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
`
SanitarySewa e Systems w
y Permit Number
Name _ 1! l� G°r� � ,//,Date •� ' �/� N2 5893
L o c a t i
/`/��if�' rJ Gt/
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Subdivision Name Lot No. Sec. or Block No.
Lot Size House I-,-' Mobile Home _ Business Speculation
No. Bedrooms No. Baths T— No. in Family -�
Garbage Disposal YES ❑ NO g-- Specifications for System:
Auto Dish Washer YES ❑ NO p•'
Auto Wash Machine YES NO ❑ p'?��X�Jlp'7
Type Water Supply ,Z1Z
*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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1
Improvements permit by _
r
*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 S621e&
44
Certificate of Completion __-Lcx� 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.
'FDAVIE COUNTY HEALTH DEPARTMENT
' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Artidle II of G.S.Chapter130a ;
Sanitary Sewage Systems Permit Number- -
Name "C; Date 'N2 5893
Location �,JP�:�,r, l�` -�� /� � � r:�iJ �r / 'il �1.. i /r7i,
Subdivision Name Lot No. Sec. or Block No.
Lot Size House 1,o� — Mobile Home Business Speculation
No. Bedrooms No. Baths No. in Family
GarbageDisposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO B'
Auto Wash Machine YES Rr'NO E] p��U,,V vc!2
Type Water SupPIY �°�� ---
*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.
ti
ff�
4
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-
Improvements P Y permit b ZZ2
,
*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 0,477 e /6�
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.