P7515 Sanford Ave F1 ..,{s+ry vv.•r....ry`4`�'(•;,�,..y�..rv._.y,+,de":�e'Y 'i^ r•:y}:�.1i'4.rwr�f}.:a���.�°"A,,-is•, c;i' y;.� .> -C _ '! :u . ''2Jv `} j �JC �/s ..
A n DAVIE COUNTY HEALTH DEPARTMENT `
VEMENTS PERMIT AND CERTIFICATE OF COMPLETION ;
•NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
S nit ryewagq Systems Permit Number
No
7515
7
Name Date �/S 9� _ t 5 1 5
Loca ' n
Subdivision'Name I Lot No. Sec. or Block No.
Lot Size I House Mobile Home — Business -- Industry
No. Bedrooms 1No. Baths _J-- No. in Family _ Public Assembly Other
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES NO ❑ �t j/ it
Auto Wash Ma^hine YES N0 ❑
All
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.
't.
i
F
-��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: P.M.on day of completion.Telephone Number:704-634-5985.
Final Installation Diagram: System Installed by v
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 as a guarantee that the system will function
satisfactorily for any given period of time.
-4
DAVIE
COUNTY HEALTH DEPARTMENT
,
- r IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
NQfiE•Issued in Compl,ance With Article 11 of G.S.Chapter 130a:,, Y
wa
OSS ;l6ryewagqSystems Permit Number
Name %�' -- Date /�S' N2 7515
' 2 Location- '�v` �� ` d'
Subdivision Name Lot No. Sec. or Block No.
Lot Size i House Mobile Home -� Business Industry
°. No. Bedrooms -_.'No. Baths ,No. in Family _ Public Assembly Other
Garbage Disposal YES ❑ N0 Specifications for System:
Auto Dish Washer YES NO ❑ /� �/ �J ,r� ,(�
Auto Wash Ma thine Y S j NO ❑ �lJ { �e�'6 1� f'J�NO'Y
Type WaterOs
uPPIY ----
This permit Void if sewage system described below is not installed within 5 years from dateofissue.
This permit is subject to revocation if site plans or the intended use change.
4 ..
J, .
t
4 M
.. A
'�.
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 ( ll�i^ t
Ov
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.