5120 Hwy 158 �, - DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems . r Permit Number
Name JfA/I l Y<�1Date _- —T! �L� N2 5812
Locati ny��er_e_x __2 rz
5120 as w 15�?'
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home — Busiriess 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.
r;
r11� 4,"
I
1
Improvements permit by �r
*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 b
4 '
Certificate of Completion Date 1/7 I
*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.
A
DAVIE COUNTY HEALTH. DEPARTMENT
�~ \IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name N� 5 812
i
..`Locatigp `s.$'" P/.�%i.`�:l.f r J: , y i/ 3/T o f : i...�•�%,, Y / -'"�,.h''4/
`,
Subdivision Name Lot No. Sec. or Block No.
Lot Size ���� House Mobile Home _ Busin`ess Speculation
No. Bedrooms % — No. Baths No. in'Family _
.-Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NOt, ,
Auto Wash Machine YES ❑ NO:` �X j,' C
Type Water Supply
*This permit Void if se tem 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.
s
,j b
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 bv`
Vv
t
Certificate of Completion � Z Date 11174.2
_
'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.