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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems Aecb�✓i J, S PermitNumber
Name )/�rP� � /✓ a� N2
Location
X,:% —� �/S'� r','C ,G,ro art �pG"
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home -- Business _— Industry
No. Bedrooms No. Baths No. in Family _ Public Assembly------Other–
Garbage
ssemblyOtherGarbage Disposal YES p NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma;hine YES ❑ NO
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
5 �
Improvements per
by —_
411
*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. G'
Final Installation Diagram: System Installed by
s
r
Jr
v, ellD
All,
Certificate of Completion —L'► Date ,•��' `93
*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.
.,u� .r,y T. 1+` �,xaM - .: ra++.." jM ! � .xy'uw�s.�` ` u vr.✓ 7 ...� 'lie. . ., ,.
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--� DAVIE COUNTY,HEALTH DEPARTMENT
IMPROVEMENTS PERMIT`AND CERTIFICATE OF COMPLETION
NOTE:Issued in Compliance WithArticle 11 of G.S.Chapter 130a S
Sanitary Sewage Systems 7 oc ✓i I�e- Permit Number
' Name r � � `pate � �-� No
�^ 7348
Location
Subdivision Name Lot No: Sec. or Block No.
Lot Size House Mobile Home — Business _— Industry
No. Bedrooms No. Baths ,ZIL No. in Family _ Public Assembly Other
Garbage Disposal YES p NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma^hive YES ❑ NO 2rf1
Typery Water Supply _ __-
0
*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.
f �
_ I -
1"
•i
y ,
Improvements permit'by __!�,41
*Contact a representative of the Davie County Health Department for final inspection of this systembetween 8:30-9:30 A.M.,-
1:00-1:30
.M.;1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704634-5985. . r r`
Final Installation Diagram: System Installed by5p _
)Jos/
h 40,
/
A07
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