P3330 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment, -and Disposal Rules (10 NCAC 10A .1934-.196) Permit Number
Name n Dat N2 3330
Location "le 11-f I
_
Subdivision Name / Lot No. Sec. or Block No.
Lot Size Housey Mobile Home Business Speculation-
No.
peculation-No. Bedrooms No. Baths No. in Family
Garbage Disposal YES j NO E] Specifications for System:
Auto Dish Washer YES NO p
Auto Wash Machine YES NO
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.
Of
Final Installation Diagram: System Installed by41 i�?�
V-
_ Certificate.of Completion _ Date fl
*The signing of this certificate shall indicate that the system des r ed above has been installedin 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
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*00TF.,Issued in Compliance with G.S. of North. Carolina Chapter 130 Article 13c
NamedSe age Treatment/and Disposal Rules (10 NCAC 10A .1934-.1968) , Permit Number
Dat -- Y'3 3330
Location��
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 ❑ Specifications for System;
Auto Dish Washer YES NO
Auto Wash Machine YES NO
Type Water Supply
`This permit Void if sewage system described below isnot 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: System Installed by
I t yv
t i
a
Certificate of Completion (X % - 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 shallin 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
. .
�
*NOTE:, I~uad in Compliance with G.S. of North Carolina {}hnpb*r 130 Article 13n
S age T Permit Number
NameDat 'q 3330
Subdivision Name Lot No. Sec. orBlock No.
'_���'
Lot Size House __�.���ubi|� Homo --��___-- Business --- Speculation
'
No. Bedrooms ---- No. Baths -_-____- No. in Fami|y----_-__- `
GadbognDispouo I YES NO O Specifications for System:
Auto Dish Washer YES NO []
Auto Wash Machine YES NO �]It
Type Water Supply
*This permit Void if sewage oyahsm described below is not installed within 36 months from do8* of issue.
`
Improvements permit bv
`
°Contacta representative of the Davie County Health Department hOr final inspection of this oyab»m between 8:30-
9:30 &K4. or 1:00'1:80 P.M. on day of completion. Telephone Number: 7U4'834 -5S85.
Final Installation Diagram: System |nutd|od by
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' V /
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Certificate of -___-
.'
'The signing of this certificate uh8| indicate that the system described above has been installed in compliance with
the ob*ndanjo set forth in the above nagu|ation, but shall in NO way be taken auoguarantee that the oyaUsm will function