1371 Hwy 64W.l V
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DAVIE COUNTY HEALTH • DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
* NOTE: Issued in Compliance With Article I I of G.S. Chapter 130a
anitary Sewage Systems Permit Number
Name % � �f' Date _ ,��____— N27538
5
I nrati n 1�0/�U Vt V /l P'//1�i� �Pl / ( /'✓.G'/�
Subdivision Name Lot No. Sec. or Block No.
Lot Size AC— House Mobile Home Business Industry
No. Bedrooms -_Z –.No. Baths--/-- No. in Family — Public Assembly Other
Garbage Disposal YES ❑ NO [y Specifications for System:
Auto Dish Washer YES NO ,��� ,�0
Auto Wash Ma^hine YES W E]NO ❑ 0&�
Type Water Supply
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
rd
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.,
1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed bywonRiV�
F
AN
Elf^)
,a5 EurN
Certificate of Completion �� 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 shalhn NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.
r --
O�
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND -CERTIFICATE-..OF COMPLETION i
;N Ec Is ued in Compliance With Article II of G.S.-Chapter 130a r
nitary Sewage Systems Permit Number
_
Name
% -� /1 Date N_ 7538
Location
Subdivyision'Name Lot No. Sec. or Block No.
,
Lot Size— House ✓ . Mobile Home —_ Business -- Industry
No. Bedrooms 12. . No.', Baths —� No. in Family _ Public Assembly Other
Garbage Disposal YES ❑ NO
AE]Specifications for System:
Auto Dish Washer YES NO
Auto Wash Ma:hine YES W NO E]
Type Water Supply efl,
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
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.,
1:00-1:30 P.M. or 4:30-5:00 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by I, ► ��U'^
f J r .. -+
j St
IFN
in
Certificate of Completion"'' �� 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.