P3461 Will Boone Rd DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT-AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Se age Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name-� �ti/t� „� Pl=� Date ,C NO 3461
Location10
f�//��ic�>r� �� �� �'1��� alp d �Y ro .���•'�/„
Subdivision Name Lot No. Z Sec. or Block No.
Lot SizeHouse Mobile Home _ Business Speculation
No. Bedrooms `— No. Baths No. in Family
Garbage Disposal YES ❑ NO ❑ Spec if1cati0ns/tpv §4 stem:
E]Auto Dish Washer. YES NO ❑
Auto Wash Machine YES ❑ NO -❑
Type Water Supply --
*This permit Void if sewage system described below is not 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
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ba/qt/
Certificate of Completion Date —
'The signing of this certificate shall indicate that the system described above as been installed in complia a with
the standards set forth in the above regulation, but shall in NO way be taken as 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
Sewage Treatment and Disposal Rules (107 NCAC 10A .1934-.1968) Permit Number
V /. /� r
Name /:%r f' �` ,' �/-,r/'/>n c — 57; ,�� / Date ��`��9/T-/- .
� 3 4 j
Location -4'i,i ,,,r r� � � �"r•�'. L `," ,/ �,.':,� �.
Subdivision Name Lot No. Seca or Block No.
Lot Size House �`— Mobile Home _ Business Speculation
No. Bedrooms No. Baths __2 No. in Family
Garbage Disposal YES ❑ NO ❑
Specifications .for, System`
Auto Dish Washer YES ❑ NO ❑ r
Auto Wash Machine YES ❑ NO -❑ (�
Type Water Supply
`This permit Void if sewage system described below is not installed within 36 months from date,of issue.
Improvements permit by F!T
'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
i
V /
Certificate of Completion Date J �• �,
#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
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name /`:� /:,• ' i/�„�`' '122 Date
Location
Subdivision Name Lot No. f Sec. or Block No.
Lot Size House �� Mobile Home _ Business _— Speculation
i
No. Bedrooms No. Baths �� No. in Family —
Garbage Disposal YES ❑ NO ❑
Auto Dish Washer YES E] NO ❑ Specifications •forystem:
Auto Wash Machine YES ❑ NO ❑
Type Water Supply
*This permit Void if sewage system described below is not 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
i
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.