131 Medical DrDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT, AND CERTIFICATE OF COMPLETION
*NOTE: Issl in Compliance with G.S. of North Carolina Chapter,130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A'.1934-.1968) Permit Number
r t c. ti4561
Name i 1t�.4,4• Date
Location r ; i , L .i
Subdivision Name 1): 7�rtrr%<<- C� tr��<y Lot No. Sec. or Block No. '
Lot: Size House ` Mobile Home_ Business - Speculation
No.''Bedrooms ? No. Baths r' No. in Family
Garbage Disposal YES ❑ NO ® Specifications for System: t
Auto Dish Washer YES ❑ NO Cfi ,
Auto Wash Machine YES ❑ NO
TOP Water Supply
-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
"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 1,SA
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.