165 Underpass Rd (2) . " DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS' PERMIT AND CERTIFICATE OF COMPLETION
NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatmen and.Dispos I Rules(10 NCAC 10A .1934-.1968) Permit Number
,�� -- f o 4119
Name Date ��,� N "
Location
Subdivision Name Lot No. Seca or Block No.
Lot Size House Mobile Home Business Speculation
No. Bedrooms No. Baths C;Z No. in Family _
Garbage Disposal YES .fl NO Specifications.for System:
Auto Dish Washer YES NO ❑ ,
Auto Wash Machine . YES T . NO ❑. fis
leo JIT /aType Water Supply*This permit Void if sewage system described belo t installed within 36 months from date of issue: `
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.
Final Installation Diagram: System Installed by
1d �
1- : 1
�s
S
Certificate of Completion Date Af PC
'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 G.S. of North Carolina Chapter 130 Article 13c
, w , Sewage Treatment and Disposal Rules (10 NCAC 10A..1934-.1968) Permit Number
Name //�',� i✓ �.///J'�� Date � �i�- . � 9
Location --
}
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 Machine YES [ NO ❑ ��d �� /r/� ,
Type Water Supply _
*This permit Void if sewage system described below is n t installed within 36 months from date of issue.
LA IkN
Improvements permit bY
1s��
*Contact a representative of the Davie County Health Departmentj 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 ��,�2 -
0 11�
iJ
F-
S
Certificate of Completion _____Tr Date r
*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
y ' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*.NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
k Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
AllName s'-7 �:. /: Date r ° ,` 119
Location `+ �'' i - ;✓ �- - /✓ . �; .L_ %�' ,` _
Subdivision Name Lot No. Sec. or Block No.
Lot Size __ House Mobile Home -'� Business Speculation
No. Bedrooms No. Baths r No. in Family f _
Garbage Disposal YES ❑ NO p- Specifications for System:
Auto Dish Washer YES NO '❑ '" '1
t
Auto Wash Machine YES ] NO ❑
Type Water Supply �_—
`This permit Void if sewage system described belo is not installed within 36 months from date of issue.
1 ,
i`
s
{
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. _ ... ._ .
Final Installation Diagram: System Installed by
'tt)1 '
�f
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.
1 ' <-
{ 2 ` t -
JOAN K. SPRY
---Y,' Commis ion-Ex ares— ---
County of Davie P
kTH CARO'-%