171 Brookdale Drive Lot 6 Section2id
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Systems �✓�� Permit Number
Name 1,41,1, ti ( /'/941 //f���'-s�7� N2
f,
Location 7/
Subdivision Name !�'f'r'.�D/�����-//l� /'� 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 ❑ n
Auto WashMa.hine YES ❑ NO ❑ ��i'l��cfQr�`� !' �� '
Type Water Supply ___ s'00,f'��/�
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This°permit is subject to revocation if site plans or the intended use change.
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:
m Installed by
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.
D"IE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE_ : Issued in Compliance With Article 11 of G.S. Chapter 130a
f Sanitary Sewage Systte►msnn �' - Permit Number
D to !i /r� N2 -,
Location
Subdivision Name
rri' `%". %%Cc'�f-��
,l;rf'r"C- -�Cot No. " � Sec. or Block No. r."�'`i• --�
/rMobile
Lot Size
House
Home ___ Business Speculation
No. Bedrooms
No. Baths
r No. in Family_
Garbage Disposal
YES ❑
NO ❑
Specifications for System:
Auto Dish Washer
YES ❑
NO ❑
Auto Wash Ma;hine
YES ❑
NO ❑
c%
Type Water Supply
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
1
Improvements permit by
*Contact a representative of the Davie County Healto 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'l Telephone Number 704-634-5985.
Final Installation Diagram:
m Installed by
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.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT 'AND CERTIFICATE OF COMPLETION
. NONE: Issued in Compliance with G.S. of North C'arolipa^ Chapter. 130 Article 13c
Sewage' Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) " Permit Number
Name`'T F' Date
., .rte* w 'cK17 'f ♦ (,i'-$✓� — V „� – � a i- �M v .- .-�-
Location
II
f,
171
Subdivision Name <�� i / :ter .- Lot No. — it Sec. or Block �^ ock No.
Lot Size -- _ House Mobile Home —_-- Business -- Speculation
No. Bedrooms T .x _ No. Baths No." in Family
Garbage Disposal YES ❑ NO Q' Specifications for System:
Auto Dish Washer YES ❑ NO ❑ `� µ
Auto Wash Machine" YES NO�� ' d
-Type Water Supply ------ �{ r
*This permit Void if sewage system described below is=not installed within 36 months from date of issue.
l�
Improvements permit by
p P Y --
*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. ,
A
fit
Final Installation Diagram: System Installed by `►%��_ .
av, 4 L
7
Al
r ;I,
Certificate of Completion/ C.� Date A7
"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 betaken as a guarantee that the system will function
satisfactorily for any given period'of time. u