1511 Jericho Church Rd (3) . 4.�,'t d1 a, t. ;� 4 a r p:'4: d.` ,- Y• Fa a t',7-i,..:, ...:. .... :`.i. r.
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
"NOTE: Issued in Compliance With G.& of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name . . - Date
3577
Location tl c�rc_ o I 'i� �., 1-���,, vim (�r fit"> ; k'ft,�z Cr"F 1 ,.
Subdivision Name Lot No. Sec. or Block No.
Lot Size House `""� Mobile Home _ Business Speculation
No. Bedrooms '2-'' No. Baths No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System: R4?A)P—.
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ NO ❑ n
Type Water Supply kK1 t _ i
*This permit Void if sewage system described below is not installed within 33 months from date of issue.
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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 Nu : 704-634-5985.
Final Installation Diagram: System Installed b
Certificate of Completion _ Date
*The signing of this certificate shall indicate that the system described above ha 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 1', 6'. ALLfIJ RT7 �� 6�S Date (9 `YNl! 3577
Location I C 0 -dau_5z_ v"�� �_ct- �A rf�,rz Cr,5-7 F=
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: 124 PAiP..
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES E] NO ❑ D
Type Water Supply ---
*This permit Void if sewage system.described below is not installed within 3 3 months from date of issue.
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LAN<,
Improvements permit by
*Contact a representative of the Davie County Health Department f4� final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone NumBe,704-634-5985.
Final Installation Diagram: System Installed b ���✓�' y `;"�?
Certificate of Completion Dates
*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.