1922 Hwy 601N ' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NOTE: Issued 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 ��� ;�,�' (' Date2Z'� � f
Location —
v
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms `- No. Baths, No.1' Family.--
Garbage Disposal YES p , NO p—
Specifications for System:
Auto Dish Washer YES [ NO
Auto Wash Machine YES rjj NO
Type Water Supply mac.. 7' ---
U
*This permit Void if sewage system describedkelg s not installed within 36 months from date of issue.
1 �
Improvements prmit by —
"Contact a representative of the Davie County Health Department fo f inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephon er: 704-634-5985.
Final Installation DiarSystem Installed by
D
Iq - h l 46
�o
Certificate of Completion Date A o J
'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.
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE; Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
h/
J J 1
Name / f,' i �G �r�-� .%" Date
Location CU ✓ .�� r!; �,i —
Subdivision Name Lot No. Sec. or Block No.
Lot Size House -ter Mobile Home __ Business Speculation
No. Bedrooms �� No. Baths `- \NoA� Family
Garbage Disposal YES NO p Specifications for System:
Auto Dish Washer YES NO
Auto Wash Machine YES NO
Type Water Supply
J
*This permit Void if sewage system described` ell o- s not installed within 36 months from date of issue.
Improvements p rmit by-:5
*Contact a representative of the Davie County Health Department to f arinspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephon m er: 704-634-5985.
Final Installation Diagram. System Installed by
61t'�
P,
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.