300 Martin Luther King Junior 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 .1934-.1968) Permit Number
Name � L��� �.�;�'�i ,-r; — Date33 1 I
Location /.; '�/�/` �- ,�� ,`r. •,;/�/i✓l'-�/' "�,� !N 1 ✓ .>; ^%i- %r;- r /� � =
Subdivision Name Lot No. _ Sec. or Block No.
Lot"Size House �A Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family _
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO r „
Auto Wash Machine YES ❑ NO ❑ �X� X16
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
I
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 bU«�
i
- Certificate of Completion Dat Z7,73;
*The signing of this certificate shall indicate that the system describ 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.
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 .1934-.1968) Permit Number
n
Name -�' ��� Date
Ld'cafion I /:`:��/ O: r',7 �.- '7� ir;��i� ,w /ti'/' ✓ �5 �"��s� / ��,,
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 J Specifications for System:
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES ❑ NO
Type Water Supply
*This permit Void if sewage system described below is not installed within36months from date of issue.
�.
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
r
Certificate of Completion � Y Date
*The signing of this certificate shall indicate that the system describ 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.