P6262 Old Mill Rd DAVIE COUNTY HEALTH DEPARTMENT X
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--IMPROVEMENTS PERMIT AND CERTIFICATE-OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a - r
Sanitary Sewage Systems Permit Number
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Name �1- J //'r../ ' i 7`.r�c:i '' '�Xi,� Date �••� "'S''/ 1�2 6262
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 p-' Specifications for System:
:- Auto Dish Washer YES NO ❑
Auto Wash Machine YES NO ❑ 4�0
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 use change.
S
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. , A
Final Installation Diagram: System Installed by
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.