1366 Yadkin Valley Rd 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 Permit Number
Name �i /� / 4 Date d C ND 6450 .
Locati // /,
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Home _T Business Speculation
No. Bedrooms _ No. Baths _ No. in Family_
Garbage Disposal YES. ❑ NO 2 Specifications for System:
.Auto Dish Washer. YES p NO ❑
Auto Wash Ma thine YES p 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.
J
L
Improvements permit b _
*Contact a representative of the D vie 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
7
Certificate of Completion - Date f®
"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 betaken as a guarantee that the system will function
satisfactorily for any given period of time.
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DAVIE COUNTY HEALTH DEPARTMENT 4
' IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
*NOTEAssuedrin Compliance With Article 11 of G.S.Chapter 130a
.Sanitary Sewage Systems ` Permit Number
Name f C" �( l�=! � Date N 6 4-5 0
Location a1 i = .>// _/J%/ie2� �.L• /.�' �� . . /�%
Subdivision Name Lot No. Sec. or Block No.
Lot Size House <Mobfl"ome _T Business Speculation
No. Bedrooms . Baths , o. in Family
Garbage Disposal ` YES,❑. NO ❑ / Specifications for System:
Auto Dish Washer YES ❑ Nq E]Auto Wash Ma.hine YES ❑ NO ❑ y/
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
Improvements permit by — ,
Xo/
Contact a representative of the Davie C unty 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 –c -
"
Certificate of Completion Y ` 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 guiarantee that the system will function
satisfactorily for any given period of time.