P4000 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 .193.,4--.v1968), Permit Number
Name /fir",�� �-����� Date r'l1 4900
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home 1� Business Speculation
No. Bedrooms — No. Baths _�� ___ No. in .Family
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 be
onths 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
Certificate of Completion (�f�"Date x�f
*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 fyr--any given period of time.
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