P2620 Edgewood Circle'
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: |aouod in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
_ Permit Number
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Name ' '�� � r Date
Location
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Subdivision Name
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Lot Size
No. Bedrooms Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
____ House
__
-No. Ba1ho-__
YES:[] NOE
YES [] NO El
YES [� NO {�
Lot No. Sec. or Block No
l
'
-_-_-_K4ub|aHome _--_-_---Bm�nnoo___-----_Soacu�Uon-_____-_
No �
in Family
' Specifications for oyuu:x/:
*This permit Void if sewage system is not installed within 36 months from dab* of issue.
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Improvements permit by
*Contact o representative of theDmvio County Health Department for final inspection of this ayuh*m between 8:30-
9:30 A.M.
:3O'D:3OA.K4. or1:00'1:30 P.M. on day of completion. Telephone Number: 7O4 -S34 -5S85.
Final Installation Oi gram:
-41,W»" ." - '
System Installed
Certificate of Completion Date
4beaken
^Tho aign|ng of thia certificate oha| indicate 1hsd the deenhau been inoba|ad in cumpiiance withthee�/nduvdaao1fo�hinthaabovonegu|aUun.butohoUinNOwayaooguaranbeoMhadtheayobemwiUfunctinn
satisfactorily for any given period of time.
�
` � ----
____ House
__
-No. Ba1ho-__
YES:[] NOE
YES [] NO El
YES [� NO {�
Lot No. Sec. or Block No
l
'
-_-_-_K4ub|aHome _--_-_---Bm�nnoo___-----_Soacu�Uon-_____-_
No �
in Family
' Specifications for oyuu:x/:
*This permit Void if sewage system is not installed within 36 months from dab* of issue.
�
� |
/ (
'
\
|
�
�
} �
'
�
'
�
' ---_-_- �
[- ~
Improvements permit by
*Contact o representative of theDmvio County Health Department for final inspection of this ayuh*m between 8:30-
9:30 A.M.
:3O'D:3OA.K4. or1:00'1:30 P.M. on day of completion. Telephone Number: 7O4 -S34 -5S85.
Final Installation Oi gram:
-41,W»" ." - '
System Installed
Certificate of Completion Date
4beaken
^Tho aign|ng of thia certificate oha| indicate 1hsd the deenhau been inoba|ad in cumpiiance withthee�/nduvdaao1fo�hinthaabovonegu|aUun.butohoUinNOwayaooguaranbeoMhadtheayobemwiUfunctinn
satisfactorily for any given period of time.
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' �Z' 1 �� L� c t2 y"t', t fi -- Date
Location
9�� ` Vit,-`r,ftCs �.(�n(-z : ;,- i i l_`�ii 3'�► �-?_t i t.Ci^, Z �--'��'i i..orr.} j ' °/C-��fi j!
Subdivision Name Lot No. Sec. or Block No.
Lot Size � - House �"f Mobile Home _ Business Speculation
No. Bedrooms No. Baths { No. in Family
Garbage Disposal YES ❑ NO 4] Specifications for System: A I i e
Auto Dish Washer YES ❑ NO p
Auto Wash Machine YES p NO -❑
I_ _ x 3 XZ`1 S,
is a!
Type Water Supply _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
G
f
iJ
l
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. ori day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed byil
{
a4i
.;Vji,
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 aken as a guarantee that the system will function
satisfactorily for any given period of time.