300 Pleasant Acre DrDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued In Compliance With Article I I of G.S. Chapter 130a h�
Sanitary Sewage Systems `� h t t� nl+, 1 1 Q Permit
+�C/� Number �(�
Name. M, so "' �i��Al7c, , �l�c^�l y..'CI�-D�te\�_11�� - ! 3 IY4 1 JJ�F
Location A AN
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'.� S ��\ 4 l\S P lJ \ ',_4c �-Jh - �. 1 .n :t'w
Subdivision Name _ Y L°D �� es_ Lol No. 3 Sec_ or Block No.
Lot Size Ilio br) House �V Mobile Home— Business Industry
No. Bedrooms No. Baths No. in Family Public Assembly Other
t
Garbage Disposal YES p NO( Specifications for Syst m:
Auto Dish Washer YES'NO [�y =. ! O0 o coq, �y� - � - � oh
;Auto Wash Machine YES Ff. NO ❑.
Type Water Supply il'Jt _
This permit Void if sewage system described below Isnot Installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
•�.� T4n� Ce+a.@ G,cGY.
ion, '-
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Improvements permit byo`-
-Contest a representative of the Davie County Hea@h Department for final inspedlon of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M. of 4:30.5:00 P.M. on day of completion, Telephone Number: 704-834-5985,
Final installation Diagram:
System Installed bye$
n f Certilicre of omplletion Date
'The signing of this certificate shall in ic, (t fat the s lent described above has been installed in compliance with
the standards set forth In the above to ulation, but shall In NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.