P2656 Hwy 801NDAVIE 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 A - Date G
Location r r,
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
YES
❑
NO p
YES
❑
NO ❑
YES
❑
NO ❑
i
Specifications for System:
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvem
permit by
*Contact a representative .of the Davie County Health Department fo final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Nu ber: 704-634-5985.
Final Installation Diagram:
System [Installed
62ZL, lei
Certificate of Completio Date A,�IOA�l
'The signing of this certificate shall indicate that the system described above has bee 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.
'
i
t
i
t
i
Improvem
permit by
*Contact a representative .of the Davie County Health Department fo final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Nu ber: 704-634-5985.
Final Installation Diagram:
System [Installed
62ZL, lei
Certificate of Completio Date A,�IOA�l
'The signing of this certificate shall indicate that the system described above has bee 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
Y IMPROVEMENTS PERMIT :AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance -with G.S. of North Carolina Chapter 130—Article 13c.
w. Permit Number
Name Date
Location «`-
Subdivision Name f. Lot No. Sec. or Block No.
Lot Size / `� �{ ` House Mobile Home _ ✓' Business Speculation
No. Bedrooms `% No. Baths No. in Family �
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
YES ❑ NO p
YES ❑ NO ❑
YES ❑ NO ❑
Specifications for System:
„'-o
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
U
L�-------------
7;1 t
f
�;1 r_...
Improvemegts permit by _— t '
*Contact a representative of the Davie County Health Department fo f .final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone NuT ber: 704-634-5985.
Final Installation Diagram: System installed Ly � f r��� � r �G 7
Certificate of Completion /4)ate/)/Ph
*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.