P4197 Main Church Rd�V
- DAVIE COUNTY HEALTH DEPARTMENT
Jr -
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: 1ssued iri,Compliance with G.S. of North Carolina Chapter 130 Article 13c ;
Sewage Treatment and Disposal Rules (10 NCAC- 10A .1934-.1968) Permit Number
Name s���/� / �/1/ %9i��,l- Date . cx�!Jr/
_. _ _ ��� 4197
J.6 -cation-`✓% / .�, r �/1��s-� .� / ii--%;'�`„�'�`j. l�f,
Vsubdivision Name Lot No. - Sec. or Block No.
Lot Size House, Mobile Home _ Business Speculation
No. Bedrooms �1___ No. Baths No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
. Auto Dish WasherYES ❑ NO' ❑����
Auto Wash Machine YES ❑ NO ❑
Type Water Supply /41 f
*This permit Void if sewage system described below is not, installed within 36 months from date of issue.
improvements permit by z
f
*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 _ Bob CO R'e.
AL2 yt/
-07
Certificate of Completion Qsr. Y\A Ct"- o Date 1
*The signing of this certificateshall indicate that the system describ d 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.
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DAVIE 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-.1968)
Permit Number
Name
:�
Date '' / _=�
F �' 197
-
Location
(-"Subdivision
Name Lot No. Sec.
or Block No.
Lot Size
House —_,----Mobile Home _ Business
Speculation
No. Bedrooms _r j — 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 i ---
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
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 1% I" - :>
Certificate of Completion 'r 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 shall in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time.