1975 Hwy 158 (3) -- ✓X it
' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
'NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewag.1 Systems � (y Permit Number
Name li.q.. ' Ad s�i� S– 1e /�. N2 6897
Locati n / ,2, .- C.� /���� OCtG� /��ln/ Y6�t os'� �i9%��/D✓P
Subdivision Name Lot No. Sec.or Block No.
Lot Size House V— 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 Ma;hine 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.
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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 —
Certificate of Completion ZkZ 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. �:.
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sag Systems ✓ Permit Number
Nam
e_�� ( Av, sas – to 2 N_O66,97
Locati n
_ _ V l '
Subdivision Name Lot No. Sec. or Block No.
Lot Size House ✓� Mobile Home _� Business _— Speculation
No. Bedrooms No. Baths —c:2— No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO. ❑
Auto Wash Ma:hive 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.
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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 .
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
= :NOT sued in Compliance With Article I I of G.S.Chapter 130a'
'Sanitary Sewage Systems Permit Permit Number
Name ji'.�L�f/ /9�., tYS 1i� G �c9te �' NO 6897
Locatipn ~�5�c�
AWV
Subdivision Name Lot No. Sec. or Block No.
Lot Size House �r Mobile Home Business Speculation
No. Bedrooms No. Baths _r-Q, No. in Family —
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma-.hive 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 tended use change.
• 1
i
Improvements permit by _ / a /
'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 ���=����'
d ,
/P
Certificate of Completion Date
*The signing of this certificate shall indicate that the system described.above has been installed in compliance with
,Jhe 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. i _�