P2233 Hwy 158,.� DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note:, Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Name
Location
Date
Permit Number
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 YES ❑ NO ❑
Auto Wash Machine YES ❑ NO -❑
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 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.
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Final Installation Diagram: 'Sl%Installed by
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Certificate of Com pletion�Date 9-(1-210 _
'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
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
dame - — 'r.. - Date
.. �,
Location
Subdivision Name Lot No. - Sec. or Block No.
Lot Size House `"� Mobile Home _ Business Speculation
No. Bedrooms L` No. Baths No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑ _
Auto Wash Machine YES ❑ NO i❑
Type Water Supply
*This permit Void if sewage jsystem described below is not installed within 36 months from date of issue.
,/4-t
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: Yste Installed by AlNA
V\ olk %
Certificate of Completion �' �Ig' - Date 9- �� ' ?0
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*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.