234 Broadway Rd (2) 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 V, tate �, I [t?k. 4 90
Location
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 MachineYES NO ,❑ �U' `� ✓" .: X
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 zxn
Certificate of Completion Date - 6
'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:,-Is'sued 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
Location
ouuo/ws/onmame Lot No. Sec. orBlock No. `
' Lot m/zo House __-___-_ Mobile Hoem
Home Business `
`
No. Bedrooms No. Bedho _-_____- No. in Fomi|y_-_---_-_
' .
Garbage Disposal YES -- NO 'K ^
Specifications for System:
Auto Dish Washer YES [-1 NO
AutoWash Machine
Type Water Supply
*This permit Void ifsewage system described below is not installed within 38 months from date of issue.
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Improvements permit by
°Cuntacto vnpnunontadiva of the Davie County Health Department for final inspection of this ayoham between 8:30-
9:30 A.M.
:30'0:3O /\.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 7O4'834'5S85.
Final Installation Diagram: System Installed by
`
~7
Certificate ofCompletion Date
'The signing of this certificate oho| 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 oftime. .