273 Danner Rd 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 .11934-.1968) Permit Number
Name LrJA4ae WF1f-tgICC-e— Date6- 9- K3 �. 309
:
Location �V-
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home —sem Business Speculation
No. Bedrooms No. Baths _ Z _ No. in Family _
Garbage Disposal YES ❑ NO ❑
Specifications for System:/p
Auto Dish Washer YES E] NO E] �
Auto Wash Machine YES ❑ NO ❑ ~
Type Water Supply At, tL _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
l
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
Certificate of Completion ��✓ Date
'The signing.of this certificate shall indicate that the system descri 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.