241 Junction Rd y
DAVIE COUNTY HEALTH DEPARTMENT
dam.
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
- *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name Lowell Cooper , Rt. 7, ,Box 532. Mocksvilbate N° 5821 -
; Approx. 8th house on lt. (towards Cooleerzee)
Location Jericho Rd. ; Lt. o Davie Academy R
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 Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES ❑ NO
Type Water Supply
*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.
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 ,fit
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.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE issued:in Compliance With Article II of G.S.Chapter 130a
.- Sanitary Sewage Systems Permit Number
.. Name Lowell Cooper , Rt. 7, Box 532, MocksvilD�te —�"'"-=��-�� NO a?
Lt. on' Davie Academy Rd.. • A r"
Location Jericho Rd.; � y , Approx.o�c. f3th douse on-7:�t.... (toward-,"Caoleea�ee)r��`"
Subdivision Name Lot No. Sec. or Block No.' 1
Lot Size House _te�'_ _ Mobile Home — Business Speculation
No.Bedrooms -' — No. Baths No. in Family. _
Garbage Disposal YES E] NO Specifications for System:
'Auto Dish Washer YES ❑ NO f1
;Auto Wash Machine YES ❑ NOG��/i� � `�` „
Type,Water �PpplY ---
*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.
1
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
A.
Certificate of Completion `* Date ? 2
The sigriing•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.