120 Valley Oaks Drive Lot 3 (I DAVIE COUNTY; HEALTH DEPARTMENT
- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Complliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name ' YV% r,,�,;• '#A f%-,1, a Date ''� 2541
Location — � a ;if ►IA, ('� . I, F�.,� 0
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Subdivision Name all Lot No. 3 Sec. or Block No.
Lot_ Size t nom_ House" +! Mobile Home_ Business Speculation
No. Bedrooms 3 i f� No. Baths No. in Family 4
Garbage Disposal' ;YES ❑ NO p. Specifications for System: qou SQ I I o "t ANK
Auto Dish Washer �IYES M_ NOaim
❑ ! �s,f a . ,E
Auto Wash Machine ;,YES [- NO ♦g F � Y 3 X
Type Water Supply I �-- _— ���, � E1�r.: Ikt. 1�r(� G•, C. J\
a d t o ♦ ^r:. �.
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*.This permit Void if sewage system ;described below isnot installed within 36 months from date of issue.
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Improvements permit by
*Contact a.representative;jof the Davie County Health Department for final inspection of this system between 8:307
9:30 A.M. •,or 1:00-1:30 ,.M. on day,of completion. Telephone Number: 704-63475985.
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Final.Installation Diagram:�I, System Installed by �• Y1��,
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Certificate of Co
mpletionDate 10
The signing of this certificate shalt indicate that.the system describe 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.
Permit Number
Name % Date
Location _
Subdivision Name I i 1,c Lot No, Sec. or Block No.
Lot Size 1 ' t House Mobile Home — Business __ Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System: ;i -,
Auto Dish Washer YES ❑ NO ❑ . ,
Auto Wash Machine YES E NO ❑
Type Water Supply (,,., i --
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
,
1
i
i
sI
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: i ' System Installed by
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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.
DAVIL COU21:.'Y HEALTH DEPART MIT
PERCOLATION 'PEST RESULTS
DATE
NAME
LOCATION
FINDINGS: HOLE 140. COMMITS
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LOT DIAGIMUM
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