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DAVIE COUNTY HEALTH DEPARTMENT 6
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
' .S nitary Sewage Systems,(�� Permit Number
Name n 09"rJl/O/��� ate N2 69,69
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business __ Speculation
No. Bedrooms --=4? .No. Baths No. in Family_
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑ _
Auto Wash Ma .hine YES ❑ NO ❑ �S �/
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.
v n permit b 1.112
Impro eme is pe 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.
Final Installation Diagram: System Installed by _
�S S OWr3
Certificate of Completion Date
"Thesigning of this certificate shall indicate that the system described above has been installed in compliance with
the tandards set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactodly.for any given period of time:
i;
DAVIE COUNTY HEALTH DEPARTMENT
j' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
•NOTE: Issued in Compliance WithArticle II of G.S. Chapter 13oa
S` Hitery 9 Y Sewage Systems Permit Number
"Name 7y `/}C.� /Date �`=_��--- ND 6969
i�:e ��
Location yr/" �%,.�,� /fir, c,.. % r 1 ,
Subdivision Name Lot No. Sec. or Block No.
Lot; Size House �I Mobile Home Business _ _ Speculation
No. Bedrooms No. Baths— No. in Family_
Garbage Disposal YES ❑ NO ❑
Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma -hive YES ❑ NO ❑ �� ` �� i'/`
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.
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 \ - �\a a_. 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.