177 Plantation Ln .. .-. , .. <i u.. ,.Aj�`..•-<r�>3Si >�µ v= :( r'� =...-a' e'�i ''-. j. .. .r �'�~ .. �" .a . "i. 'y, ir.lf t—^i/,��/,y� ,
DAVIE COUNTY HEALTH DEPARTMENT
"y. IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION.
9�
Pi *NOTE:Issued in Compliance With Article I I of G.S.Chapter 180a
Sanitaryewage Systems Permit Number
Nam �,o ,o �/�� �� � Gl' - .C� Date ��`a�.? �� N2
67 � q
Location /�" '�d 5�D/- / !l' n , r, %Vii: �� �i71-
ln�L.r �
Subdivision Name Lot No. Sec. or Block No.
Lot Size Housey� Mobile Home Business -- Speculation
No. Bedrooms No. Baths "y No. in Family
Garbage Disposal YESNO ❑
Auto Dish Washer. YES p NO ❑ Specifications for System:��jf�/ --
: Auto Wash Ma thine YES [h NO ❑ ��y��r�yl���
Type Water Supply
*This permit.Void if sewage system.described below is not installed within years #o date of issue.
This permit is subject to revocation if site plans or the intended use chang .
D LA�
�o re
�d
Improvements permit
*Contact a representative of the Davie County Health Department for final insp ct' n o this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number 704- 34 598 .
Final.lnstallation Diagram: System Installe y
C� -`6
-/ D X3
9000
���—• �a� -fie e�J"
Certificate of Completion - 4Z Date 7�
'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. i
DAVIE COUNTY HEALTH DEPARTMENT
"IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NOTE`Issued in Compliance With Article II of G.S.Chapter 130a
*,Santary Sewage'8ystemsPermit. Number
Nam .
Date `S� � ✓ N2
1�- - 'v �o�- ry J ;rte
Location ' - — - -:,� f� �
Subdivision Name Lot No. Sec. or Block No.
Lot Size � '`�7C House �� Mobile Home —� Business Speculation
No..Bedrooms J No. Baths_'51 — No. in Family
—
Garbage Disposal YES [j NO ❑ Specifications for System: '9��r�� �
Auto Dish Washer YES 4 NO ❑ 0
Auto Wash Ma thine YES [lj NO ❑ / ytx �l���
Type Water Supply NZ/
*This permit Void if sewage system described below is not installed within 5,/years fro date of issue.
This-permit is subject to revocation if site plans or the intended use chang6.
lit
ON
J i t
. Improvements permit
*Contact,a representative of the Davie County Health Department for final insp ct' n o this system, between 8:30- . g
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number 704- 4 598 .
Final Installation Diagram: System Installed y �
?A-2
/TD X3 yt)
aDoo ,
Q
L_JS
Certificate of Completion --Ila Date" ��—
*The_signing of this certificate all 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 fhb system will function
satisfactorily for any given period of time. = `.'-
.