113 Orchard St 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 SAv/-\nlA-Yf VAY/Jc Date
Zf—
V( 5 i�fi 1 Q'11 �i,�' ' S S%A n JI^. Cly^ 6 /
L/o/cation 6 � - /�ti'���> •�v
1�►ort7 (r��ftiti= j'/t vc r1�z__c �;ot J C[ fT s� �i��`•xsF Com-_ Lf/''
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 ❑ r e ,�
Auto Wash Machine YES ❑ NO -❑ IDo X 3 X I? S M".r-
Type Water Supply P;,oX
I
`This permit Void if sewage system described below is not installed within 36 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 Number: 704-634-5985.
Final Installation Diagram: System Installed by Cfeztj P�2525A 'OI
Certificate of Completion Date
'The signing of this certificate shall indicate that the system describ d 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.