1977 Liberty Church Rd (2)DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND; -CERTIFICATE OF CC
Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c._.
c�
Name � _ `� Date & - _-- – els
Location Ctf
3
/AIA7Pe 5l�c.
,Subdivision Name Lot No
CIoff Im
Permit. Number
Sec. or Block No.
Lot Size House Mobile Home _ Business �Speculation
No. Bedrooms — No. Baths — Y� No. in Family
Garbage Disposal YES ❑ NO ❑
Specifications for System:
Auto Dish Washer YES ❑ NO ❑ P r 't _
Auto Wash Machine YES ❑ NO ❑ S° r felc
Type Water Supply_'
upply
`This permit Void if'sewage system described below is not installed within 36 months from date of issue.
Al
c d tAl
y
Improvements permit by;f``�'
*Contact,a representative of the Davie County Health Department for final inspection of this
9:30 A.M. or 1:00=1:30 :P.M. on day of completion. Telephone Number: 704-634-5985.
i
System Installed by
8:30-
�
Certificate of Completion
#The signing of this certificate shall indicate that the system described above has been installed incompliance 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.