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134 Powell Road Lot 3�- 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 Date2049 Location Location _ kna uJ Subdivision Name W,0400 ar" Lot No. 3 Sec. or Block No. Lot Size House , ✓� Mobile Home Business Speculation �--^- R No. Bedrooms No. Baths ` / No. in Family Garbage Disposal YES .❑ NO R+ Specifications for System: t'j 00 (Ra * 1LIt Auto Dish Washer YES NO Auto Wash Machine YES NO ❑ y K_ Type Water Supply ���� ",-T4 A _ • n' *This permit Void if sewage system described below is not installed within 36' months from date of issue. , l is ; H Improvements permit by ' x Ad I.Ij *Contact a representative of the Davie County Health Department for final inspection of this system between. 6.30- 9:30 A.M. or 1:00-1:30 P.M. on day..of completion. Telephone Number: 704,-634-5985. Final Installation Diagram: System Installedby; ���. F-4 f- II ji 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. f. r, r, DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 MOCKSVILLE, N. C. 27028 (704) 634-5985 Statement for Septic Tank Improvement Permits and/or Site Evaluations NA14E a,,`;�Q �,1 DATE ISSUED l2 ) iP ADDRESS Z 1S S�ti.s PERMIT NO. :k(yj'i Explanation of charge�,,.��,. per- �►.� "'� . AMOUNT DUE SANITARIAN PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.