P7442 Sanford Ave CL, - 5'1,t'(.�fy"�t.�+�+�' rsTt' �'i:..i.4Md� IL.j.f ry„ '�� ,�,oeS'v;.,N r,.-c+hy,J'4NW` 'T.srn'� 'w.:".ys Y�i.�:�^e .r n`'S'"1•n¢.a+•jix� .Y�, 1 w,4..� ;„{1.'
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article Il of G.S.Chapter 130a
Sanitary Sewage S stems Permit Number
Name X146 tn� Date l N2 14 4 2
Locatio 0/ell 9
Subdivision Name Lot No. Sec. or Block No.
Lot.Sin House Mobile Home --� Business -- Industry
No. Bedrooms --- .--.No. Baths No. in Family _ Public Assembly Other
Garbage Disposal YES ❑ NO g-- Specifications for System:
Auto Dish Washer YES NO ❑ L -,i
Auto Wash Ma shine YES [� NO ❑ –� o`�wX� �
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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Prs :�� 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.,
1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985.
Final Installation Diagram: System Installed by _ tacy``C— '
to
,
t
Certificate of Completion Date b � J�
'The signing of this certificate shall indicate that the system describ d 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
NO ,issued in Compliance With Article 11 of G.S.Chapter 130a ->
Sanitary Sewage Systems Permit Number
_L� 7/ /� �r Date ---V- -%� 0 7
Name -,-. ;,..__...�r�, �r.�� - -� 14 4
Locatio !7 —
1
Subdivision f fame Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business — Industry
No. Bedroopts _.No. Baths No. in Family — Public Assembly Other
Garbage DisposaT`. YES ❑ NO [ Specifications for System:
Auto Dish Washer YES NO ❑ y �'
Auto Wash Ma thine YES NO ❑
i
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.
r
f/r
Improvements permit byl- 'L
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-9:30 A.M.,
1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985.
Final Installation Diagram: System Installed by
� 1
T
0
Certificate of Completion Date
The signing of this certificate shall indicate that the,.system describ d 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.