147 Bethlehem 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
Sewage Treatment and Disposal Rules (10,NCAC 10A .1934-.1968) Permit Number
Name ,rs1� ;t �,r�'/� t � .�'G;r'� ✓✓���/ Date7� h'
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House, I�Mobile Home _ Business -- Speculation
No. Bedrooms �— No. Baths -A No. in Family
Garbage Disposal YES ❑ NO ff�_ Specifications for System:
Auto Dish Washer YES NO ❑ , yr` / r�
Auto Wash Machine YES NO ❑
Type Water Supply __—
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
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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 SZZ�0�
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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.-'
' ]s- ed in Compliance vvithG.G. of North Carolina Chapter 130 Article 13n '
Sewage Treatment d Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
All'.mum�
_
Location
Subdivision Name Lot No. Sec. orBlock No.
Lot Size House K4obi|eHome -_-___-_ Business __-_-_-_ Speculation
----__--_
No. Bedrooms No. Bath No. in Family
Garbage Disposal YES E) NO U.— Specifications for System:
Auto Dish Washer YES NO F-1
-- Wash— Machine— YES Y�
�
Tvoa Water Supply
*This permit Void ifsewage system described below is not installed within 36 mnrdha from doh* of issue.
Improvements permit by 711
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°Contacta representative of the Dave 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: TU4'G34'5985.
Final Installation Diagram: System Installed by
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Certificate of Completion Dote
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards set forth inthe above regulation, but shall inNOway be taken aoaguarantee that the system will function
satisfactorily for any given period of time.