133 Valley Oaks Drive Lot 21 DAVIE COUNTY HEALTH, DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
i i j Permit Number
Name i' ,, Date – Z 4- ° ;` f2
Location ' K� \�a�►teC-�wa ► ��a —
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Subdivision Name 016L i6� Lot No. i Sec. or Block No.
Lot Size Ho' K 1 c1 i House Mobile Home — Business Speculation' c...---
No. Bedrooms No. Bathsl! No: in Family
Garbage Disposal YES I❑ NO 0-
Specifications' for System:
Auto Dish Washer YES p--- NO .❑ ZOO'
Auto Wash Machine YES p, NO ❑ t� ��
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Type Water Supply
*This permit Void if sewage system,;described below is not installed within 36 months from date of issue.
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ii Improvements permit by
'Contact a representative of the Davie County Health Department for final inspection .of this system between 8:30'-
9:30,
:30-9:30. A.M. or 1:00-1:30 P.M. on day,. of completion. Telephone Number: 704-634-5985.
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Final Installation Diagram: 4 System Installed by
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!� 4 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 i'n' 'the above regulation, but shall in NO way be taken as'a guarantee that the system will function
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satisfactorily for any given period of.time.
DAVID; COUTM HEALTH DEPARTMNT
PERCOLATION TEST.' RESULTS
DATE
NAME �� 2 ►�w. .r.o.
LOCATION U a 11c, VQ K3 a
FINDIIdGS: _HOLE 110. COMMI T'S
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