P6753 Baltimore RdC. y� /Xo
DAVIE COUNTY HEALTH DEPARTMENT
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IMPROVEMENTS PERMIT AND . CERTIFICATE OF COMPLETION J
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
Named v .%P/�i ,,_�l� Date NO
6753
Location �' t f4/�ia .� �� %iii° D's✓ �`'�/J/%1-S� \%��,;� �l�J�<./�s`r�
Subdivision Name Lot No. Sec. or Block No.
Lot Size 7�� House �IMobile Home Business Speculation
No. Bedrooms, No. Baths __ No. in Family —
Garbage Disposal YES [� NO ❑ Specifications for System:
Auto Dish Washer YES NO 4 ❑ %
kk /e
Auto. Wash Ma.hine YES L'J NO ❑�U��xI�
Type Water Supply 6 _
*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.
05
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 S - S 9 2
*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 COU TY HEALTH DEPARTMENT o d
- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION —
*NOTE: Issued in Compliance With Article I 10 GIDS. Chapter.;130a
Sanitary Sewage Systems II Permit Number
Name „J�✓ �P Date,
NO
/ n -
.6753-
Location/
/�i I r'.� -D'j✓ �P�//TS . \� .h d�uG.��,';l
Subdivision Name III Lot No. Sec. or Block No.
II
Lot Size "AG House �' I obile Home _ Business Speculation
No. Bedrooms No. Baths III
r_: �� No.• in Family_
Garbage Disposal YES No. ..p
Specifications for System:
Auto Dish Washer. YES NO
Auto.Wash Ma.hine YES, NO p3x��
Type Water Supply �a
*This permit Void if sewage -system described be w is not installed within,5 years from date of issue. -
This%permit is subject to revocation if site plans °or the intended use change.
• • P
°t�rn
Improvements permit by —_.f
'—
*Contact a representative of the Davie County Health Department for final .inspection of this systembetween 8:30-
9:30 X.M.' or 1:00-1:30 P.M. on day of completid' . Telephone Number 704-634-5985.
Final Installation Diagram: System Installed,by
Certificate of ,Completion C�-� 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. �II