P4751 Gladstone RdDAVIE COUNTY HEALTH DEPARTMENT
1
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 1"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
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Name �:- >��.. � _ �, �. � � Date � 4J J
VC-,
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home — BusinessSpeculation
No. Bedrooms No. Baths No. in Family _
Garbage Disposal YES :❑ NO Specifications for System:
Auto Dish Washer YES ❑ \ NO_[[-,
Auto Wash Machine YES ❑ NO 16._
Type Water Supply ---
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
*Contact a 'representative 4of 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:
11
System Installed by—�
C- R� '4 -
Certificate of Completion Date 2o - o
'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.
DAVIE COUNTY HEALTH DEPARTMENT
.IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment and Disposal Rules (1,0 NCAC 10A .1934-.1968) _ Permit Number
Name -- Date
Location -= r �.• -� 4 -.`y —
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business' Speculation
i �.. /J
No. Bedrooms No. Baths ! No. in Family _
Garbage Disposal . YES ❑ NO S Specifications for stem:
Auto Dish Washer YES J E] NO
p y
Auto Wash Machine YES ❑ NOj
Type Water Supply r f ] , A N _—
"This permit Void if sewage system described below is not installed within 36 months from date of issue.
X14 •.
I i
L
Improvements permit by
0
"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 bye.
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t
Cl
�1
�c, C I
Certificate of Completion dry Date Ll 1 - G
"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.