P3195 Legion Hut RdDAVIE COUNTY HEALTH DEPARTMENT
u IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name L ,� �t a 1 E� Date - $ a !'
Location 7. Z+' Tu ?;L)tn ;>!% r)e, + 6-e,1. 6 e, l_,C V�'X— r o 2�
Subdivision Name Lot No. Sec. or Block No.
Lot Size 10 0° X Z House Mobile Home Business Speculation
No. Bedrooms -- No. Baths - No. in Family 3
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
YES ❑ NO Ej-
YES p' NO ❑
/LYES p' NO El
Specifications for System: to o o
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Lt r L� • "7 C\
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 7E,44
\ r,
Certificate of Completion 11- �Q, Date I -3 - 3
*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.