P6500 Sain Rd ' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a00,4
Sanitary Sewage Systems uC�rYv, c i`4 Permit Number
NameDate N0
Location ( ,n<PirJ��a Ste,`;✓ //�/i '
d
-Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _T Business —_ Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO iY Specifications for System:
Auto Dish Washer YES NO ❑ f
Auto Wash Ma,hine YES NO ❑ � y .S'X•� .' .. .
Type Water Supply t6 _--
*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.
INN
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F
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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.
c
Final Installation Diagram:' System Installed by -�
I�
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 of,time.
DAVIE COUNTY'HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND -CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.CChapter 130a � .
Sanitary Sewage S stems n�/�Y��`/f ` Permit Number
Name�! � �' �. `� ate ';�� / N0
i TTrfT">T'r�T 0
Location lf^; , � `;✓ 01
_
—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 Specifications for System:
Auto Dish Washer YES NO ❑
:Auto Wash Ma:hine*, YES NO ❑ � i��.i/�� F:
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.
i
10, CX
Improvements permit bY _� CL
*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
G
Certificate of Completion ' Date
*The signing of this certificate shall indicate that the system described above has been installed in-complian a 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.