P5900 Hwy 801SAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article I I of G.S. Chapter 130a
\p5nitary Sewage Systems Permit Number
Name `10� �C` c� s� e-.- R7"3-.��l ±X1__'"-1Date N2 5.19 0
Location r
V.. .
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family_
Garbage Disposal,, YES p NO 21/, Specifications for System:
Auto Dish Washer t YES p NO
Auto Wash Machine -YES NO Q o
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.
��Improvements permit by C_�
*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
r�
.O I
C rtificate of Comp a io ` • Date _ v
'The signing of this certificate shall indicat that the system described above has been installed in compliance with
the standards set forth in the above regulat all in NO way be taken as a g rantee that the system will function
satisfactorily for any given period of time.
V
COUNTY HEALTH DEPARTMENTS .
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
* NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a --=
'-` _ S�nitary Sewage Systems Permit Number
Name �� �` `� .. - .". tiv�Date - � i� NR 5900
Location -
3- ,aQ
Subdivision Name Lot No. Sec. or Block No.
Lot Size _ House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family_
Garbage Disposal, YES ❑ NO L Specifications, for System:
Auto Dish Washer ; YES E] NO p ..,..
Auto Wash Machine " AYESpNO ❑
5, x
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.
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�"'�`
y
I
Ce ificate oio 3 Date - L_
"The signing of this certificate shall indicat that the system described above has been installed in compliance with
the standards set forth in the above regulati is all in NO way be taken as a gu rantee that the system will function
satisfactorily for any given period of time.