4383 Hwy 801N 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
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Name �� `-�'� �� , T �- �- Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House L Mobile Home _ Business Speculation
No. Bedrooms — No. Baths — — No. in Family (to -
Garbage Disposal YES ❑ NO p' Specifications for System:
Auto Dish Washer YES [D/ NO ❑ �,c, ��. _� _, �. L �r
Auto Wash Machine YES EK NO -E-
Type
❑Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
f- /
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 by44d&��
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Certificate of Completion D tof ` S�
IF
'The signing of this certificate shall indicate that the system described above has been s all\d in o pliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee �t tt�e system will function
satisfactorily for any given period of time. \
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION Qs ..
'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 ----. Date C� r r{F'�t
Location
--� —
y -
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business Speculation
No. Bedrooms tD_ No. Baths r No. in Family
Garbage Disposal YES ❑ NO ❑ U' Specifications for System:
Auto Dish Washer YES ❑ \/NO ❑ �_. -' 'r
Auto Wash Machine YES ❑ LNO -❑ -
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
�.r
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
J
ti ✓v �
Certificate of Completion ,: � — `D to
*The signing of this certificate shall indicate that the system described above has beenstall�d in o pliance with
the standards set forth in the above regulation, but shall in NO way be taken as a guarantee tf�pt the system will function
satisfactorily for any given period of time.