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P6776 McCullough Rd DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION % *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary)Sewage Systems �/ �O -,11 -7 �/u�l'/�� Permit Number Name /T /�S �'1�r�7,✓ 6r��o S� g{e "�- N- �+ I T . Location Co / 9` % bp�✓Fl��PY Ali o ,c � U ri 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 Ma shine YES LJ NO ❑ r4ill n 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 us change. ,, rl! f � Improvements permit.by f *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 l W 1h Certificate of Completion Aw 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. \ ,t -. .,: .....,. • � rva.w .•K-Fl u-• ...itJl" . °. v `i... ... .. ti -i° ,. .. r. DAVIE COUNTY HEALTH DEPARTMENT .., IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION =*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a \ riS�niitary/Sewage Systems ;©,��/� � �'oN % %�'�� /" Permit Number - Name O N� 6776 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 F]- Specifications for System: Auto Dish Washer YES NO ❑ Auto Wash Ma-.hive YES NO ❑ Type Water Supply /76",(?`-Y)> > 1/9 -A NC C *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 us change. Improvements ermit b � Y *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 704-63475985. Final Installation Diagram: System Installed b�- t 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.