P5508 Hwy 601S_ t „
DAVIE COUNTY HEALTH DEPARTMENT
S IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
ewage Treatmerlt and Dispo5V Rules (10 NCAC 10A .1934-.1968) Permit Number
Name �� Ftl//p vc ' /�i� �i�; r 0 t
'ter . �� L��T^nsv' Date N_ 0
Locati/G
0
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business _ , -. -tpeculation
No. Bedrooms No. Baths No. in Family_
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO V
Auto Wash Machine YES ❑ NOX-fit
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. \
Final Installation Diagram: Syst�m Installed by °u'Ge a- PRa Sa e'��c. ro,
Certificate of Completion �� C�Date —% y
*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.
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT. AND CERTIFICATE OF COMPLETION f
ti (VOTE. fsswa a TreatmennCandiDis o af'Rules Carolina Chapter.
OAt .1934-.1968)
01Article 13c
g p6 ( 9ss) Permit Number
Name lazes %,� s 'Date �J /�-`3p Hoo
N_ Hoo
Locat
Subdivision'Name 1' Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business _y - ''''speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO v r
Auto Wash Machine YES ❑ NOj�.3"^
Type Water Supply
*This permitVoid 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 dayof completion. Telephone Number: 704-634-5985.
Final Installation Diagram: Syst m Installed by °"�'�� AR
v � p
Certificate of Completion �'� Date-
'The
ate "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: