3374 Hwy 158 (2) DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name ,! //1,r:;F' r, y;;f< Date ✓, S c., �_ �'
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business Speculation
No. Bedrooms r=� No. Baths' _ No. in Family
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer . YES [] NO ❑
Auto Wash Machine YES,[T] NO ❑
Type Water Supply
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'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: 20 �� System Installed by5
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Certificate of Completion J4—rn Date ✓g3
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
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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: Issue`'d'n Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date
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 p NO
.Specifications for System:
Auto Dish Washer YES f NO ,0
Auto Wash Machine YES' NO p
Type Water Supply G...1
V --
'This permit Void if sewage system described below is not installed within 36 months from date of issue.
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c
i
r
I -
Improvements permit by✓�%h��
"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.
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Final Installation Diagram: f� System Installed by
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Certificate of Completion Date ��3
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*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.