P2866 Farmington RdDAVIE 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 Date
Ol'�S �o
Location —
Subdivision Name Lot No. Sec. or Block No.
Lot Size
No. Bedrooms
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply _
House Mobile Home _ Business Speculation
_ No. Baths y No. in Family_
YES ❑ NO ❑ Specifications for System: l _
YES ❑ NO ❑
YES ❑ NO ❑
'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 byl� �
d
Certificate of Completion Date
"The signing of this certificate shall indicate that the system descr d 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 Junction
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note:assued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name �'1 + �• '1%) `_ I Date
Location I
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business Speculation
No. Bedrooms °=' No. Baths=' No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer - ,AYES p� NO fl
Auto Wash Machine YES p" NO ❑ r
Type Water Supply G -I r _ _ u iu
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
FA
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 RM. on day of completion. Telephone Number: 704-634-5985.
Y
Final Installation Diagram:
r
System Installed by UJ Al Kai'
Certificate of Completion`" "�� Date , /
"The signing of this certificate shall indicate that the system descried 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.