991 Deadmon Rd V
DAVIE COUNTY HEALTH DEPARTMENTIMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
: 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 �"t 3
Location ,; F—
-rr T
Subdivision Name Lot No. Sec. or Block No.
Lot Size — House Mobile Home _ Business Speculation
No. Bedrooms ? No. Baths —L— No. in Family —
Garbage Disposal, YES ❑ NO g--- Specifications for System:
Auto Dish Washer . YES NO ❑ 1/
Auto Wash Machine YES NO -❑
Type Water Supply i11 X.�A,•
*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 �Xjf!
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*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 •7L�
C=7
Fi'
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Certificate of Completion + Date3I 7-LS?
*The signing of this certificate shall indicate that the system describ d 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 G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968)" fi Permit' Number
Name Date ' / ?•_:�
c. ,
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size _— House -'"-Mobile Home — Business —_ Speculation
No. Bedrooms 1 No. Baths ,� No. in Family r? —
Garbage Disposal YES ❑ NO 0, Specifications for System:
Auto Dish Washer YES Q NO ❑
Auto Wash Machine YES [P NO ❑ r'./,�C� .�� =��-� ��
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
1
t Ii -
I
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 by
N
F•c��
1
Certificate of Completion �'la^^�� Date 1,�-7
'The signing of this certificate shall indicate that the system describ6 d 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.