P3162 McClamrock RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Notes. Issued in Compliance with G.S. of North Carolina ,Chapter 130—Article 13c.
Permit Number
Name r'� r� �rlr ,% -�: ;,rte . Date,>' !`'''•i ''`31,62
fid ! '��"i✓'`/''/. r'''.�:
Location —
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Subdivision Name Lot No. Sec. or Block No.
Lot Size ,�a'p;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 is not installed within 36 months from date of issue.
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;[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.
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Final Installation Diagram: ,n�D,►- �^"""�" '--system Installed byCf-OTTS
Certificate of Completion 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 it NO way b taken as a guarantee that the system will function
satisfactorily for any given period of time.