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_J DAVIE COUNTY HEALTH. DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION -
*NOTE:'Issuedin Compliance With Article I I of G.S. Chapter 130a _
Sanitary Sewage Systems , Permit � Number
Name
Date
_N2 6581
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms 3 No. Baths I ' No. in Family
Garbage Disposal YES ❑ NO d Specifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Ma shine YES UJ NO ❑
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.
6JA''d
k-- x)J
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: System Installed by��U
v
IF
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1�
QL
Certificate of Completion
*The signing of this certificate shall indicate that the system describ d
the standards set forth in the above regulation, but shall in NO way b tak
satisfactorily for any given period of time.
Date
ove has been installed in compliance with
n as`a guarantee that the system will function
A
ruE
yrs
r,
Date
ove has been installed in compliance with
n as`a guarantee that the system will function
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DAVIE COUNTY HEALTH DEPARTMENT °
s IMPROVEMENTS PERMIT AND . CERTIFICATE OF COMPLETION
*NOTE.'Issued in
LCompliance With Article II of G.S. Chapter 130a
Sanitary_Sewage Systems Permit Number
Name ��r ��° , .1� %✓ �/, .d pi. r' f �� Date —L/- ZJ - f ND
6581
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size // House 1--' Mobile Home _ Business __ Speculation
No. Bedrooms No. Baths F� No. in Family_
Garbage Disposal YES ❑ NO Q' Specifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Ma thine YES NO ❑�
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.
ox
to
r
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: System Installed bys-
C,
6L1
Z 1
a
�ica�i�te'ofCompletflon _
'The signing of this certificate shall indicate that the system descrit
the standards set forth in the above regulation, but shall in NO way b
satisfactorily for any given period of time.
.J 1
```��,..'`a Date
Love, has been installed' in compliance with
%n as a guarantee that the system will function
l:
a.
.J 1
```��,..'`a Date
Love, has been installed' in compliance with
%n as a guarantee that the system will function
l: