190 Fork Bixby Rd DAVIE COUNTY HEALTH DEPARTMENT ---�
~. IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION'� �1
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 Date
Location `�'1 �'
Subdivision Name Lot No. Sec. or Block No.
Lot Size i House � Mobile Home _ Business Speculation
No. Bedrooms 172", — No. Baths No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO.
Auto Wash Machine YES 1 NO ❑
Type Water Supply
`This permit Void if sewage system�described below is not installed within 36months from date of issue.
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y _
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
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I
Certificate of Completion Date
signing of this certificate shall indi,_ "'hat the system descr�ed� h s een inIstalle
��,ards set forth in ve regulation ut shall in NO waybe taken a
�o.=arry given period of time.