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112 Juney Beauchamp Rd DAVIE 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 Name '`rr :'s'.f' e J,� `.!� Al— Date Location u N �1 mac( l'y11� 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 ❑ NO p-- Auto Dish Washer YES [J ❑ Specifications for System: NO Auto Wash Machine YES [Q NO ❑ Type Water Supply r`"' `—" _— _ f r 23 *This permit Void if sewage system des ribed Low is not installed'within 36 o hs,frm date of issue. / r 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 M71, Certificate of Completion (! '%� J" 1J� 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. s DAVIE COUNTY HEALTH DEPARTMENT P . 0. BOX 57 MOCKSVILLE, N. C . 27028 (704) 634-5985 Statement for Septic Tank. Improvement Permits and/or ' tie/Evaluations NAME 'G©/l�i� l� /ems �� DATE ISSUED ADDRESS PER14IT NO. 'Explanation of charge "00- ,. . AMOUNT DUE (i SANITARIAN PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.