437 Peoples Creek Rd Ade �S� 2%30-3�w Ao
DAVIE COUNTY HEALTH DEPARTMENT
�IMPROVEMENTS
PERMIT AND .CERTIFICATE OF COMPLETION
NOTE:'Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name No
Location 7�9
Subdivision Name Lot No. Sec. or Block No.
Lot Size _ House Mobile Home 4.:�_' Business Speculation
No. Bedrooms 3 No. Baths _ No. in Family __
Garbage Disposal YES ❑. NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑ ce��
Auto Wash Ma shine YES ❑ NO ❑ a
Type Water Supply __ Gl/lf 2oa �Xat�z"
*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.
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Improvements permit by
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*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 m`C«- Z.&c-k«c-
:?.o• ZLotst C�43-G4?4
stL Ott
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Certificate of Completion �^ ' Date - 3 LL
.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. -
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/��f DAVIE COUNTY HEALTH DEPARTMENT
J � r-'l IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
fl e�NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
f; --Sariitary Sewage Systems Perlmlt,Nulmber
Name o0,/d YZ1 Irl T Date-—.F� - �� 0
Location ` �. ^/ ��y /t'T '�,� os /,�%��'�' �
Subdivision"Name Lot No. Sec. or Block No.
"Lot Size House Mobile Home _ r./ Business Speculation
No. Bedrooms �- No. Baths 2 No. in Family _
-Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑ ,�
��z��.
Auto Wash Ma shine YES E] NO E] � r�/�a A9 w `
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.
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Imp o e ents 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'
�.o ILzc S3- 6474
F
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 oftime.