P3506 Deadmon RdDAVIE COUNTY HEALTH DEPARTMENT
"= IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number
Name Date Z 7�%�i_��J�i�7
Location i% ; /114
Subdivision Name Lot No.
Lot Size "`a House Mobile Home.
No. Bedrooms `- No. Baths— No. in Family _
Garbage Disposal YES ❑ NO D---'
Auto Dish Washer YES NO ❑
Auto Wash Machine YES NO ❑
Type Water Supply^~ _,
Sec. or Block No. I � / y
Business Speculation L --
Specifications for System:
"This permit Void if sewage system described below is not installed within 36 months from date of issue.
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 Wkoa-
17-50-
Certificate of Completion `� Date
'The signing of this certificate shall indicate that the system describe 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.