125 E Valley View Rd Lot 21j' DAVIE COUNTY H LTH DEPARTMENT
.
i IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
S'e'wage Treatment and Disposal Rules (10 NCAC 10A .1934:.1968) Permit Number
Name _� ��.'r����'ay� i�r'�I<' �� Dae%/�%' NO
Location.
Subdivision Name Lot No. Sec. or Block No.
Lot Size
House Mobile Home _ Business __ Speculation
No. Bedrooms "/'� No. Baths --t No. in Family
:2
Garbage Disposal YES NO ❑ Specifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Machine YES NO -❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
4f
0
Improvements permit by A'a,/�
*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
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 i
IMPROVEMENTS PERMIT AND CERTIFICATE. ,OF COMPLETION I
*MOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and ,Disposal Rules (10 rj_CAC 10A .1934-.1968) Permit Number
—Name l (/_ �/rsr�, '������'��� � ' // /'� Date N2,
Locati-on IL,
Subdivision Name
Lot No
Sec. or Block No
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths ` No. in Family ::2 -
Garbage. Disposal YES NO ❑ Specifications for System:
Auto Dish Washer YES NO ❑ V�
Auto Wash Machine YES NO -❑
-Type Water Supply �>
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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. Telephone Number: 704-634-5985.
Final Installation Diagram:
System 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.