1922 Hwy 601S �f $a
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-.19/68) Permit Number
Name P(ATII /� r>f )77Date �?L/ � tj3534
3
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 p NO
p Specifications for System: %?f� L
Ai/
Auto Dish Washer YES NO
Auto Wash Machine YES LJ NO Zoo
Type Water Supply
*This permit Void if sewage system described belgw is not i stall d 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. leph e Number: 704-634-5985.
Final Installation Diagram: S ste Installed by SIL JAL
Certificate of Completion Date
*The signing of this certificate shall indicate that the system described Bove 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 2 X171( M,4Rf. OZ7 G6va' 6 k /{ Date 2- P'1 33,534
Location D u7/f m- r �}c i?�.sr -ylyy_ �l oc CIIs cf��t5iv
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: /2fe/t l/L-
Auto Dish Washer YES a NO ❑ i
Auto Wash Machine YES NO -F-1Z0O"X 3 h� $"S"/7iN
Type Water Supply 6oL!. 1
- *This permit Void if sewage system described below is noti stall d within 36 months from date of issue.
Qortf
1 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. leph a Number: 704-634-5985.
Final Installation Diagram: S ste Installed by Jltt-
Certificate of Completion Date
"The signing of this certificate shall indicate that the system described ebove 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.