P2961 Hwy 601SDAVIE 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 of r, l J.
Location.;-
✓ moi.
Subdivision Name Lot No. - Sec. or Block No.
Lot Size House Mobile Home — Business __ Speculation
No. Bedrooms r No. Baths No. in Family
Garbage Disposal -YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑ r_.
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.
S
1
t
r
i
Improvements permit by ?
'Contact a representative of the avie 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: NJ System Installed by 'TUC���Sc��i���✓
v
Certificate of Completion`�
Date ' 3
*The signingof 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
Name r. i` - Date ` f
Subdivision Name
Lot No.
Lot Size House , ' Mobile Home
No. Bedrooms No. Baths No. in Family.
Garbage Disposal YES ❑ NO ❑
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES ❑ NO 0
Type Water Supply />
`This permit Void if sewage syste
Sec. or Block No.
Business Speculation
Specifications for System:
described below is not installed within 36 months from date of issue.
Improvements permit by ' r%
ti
I
"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 Jday of completion. Telephone Number: 704-634-5985.
1 .il
Final Installation Diagram: System Installed by
6Q
Certificate of Completion �, ' 1 r�` ° Date
*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.