P2278 Rainbow RdT> ,
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NIssued in Com liance with G S of North Ca mrol' Cer
Ch t 130—Art' 1 13
-
_ Permit Number
Name- Date Y,
fr . ?
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 is not installed within 36 months from `date /of issue..n�
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��✓���' Improvements rmit 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:
4
Certificate of
*The signing of this certificate shall indic�ttrar tfTu-s-y
the standards set forth in the above regulation, but shall
satisfactorily for any given period of time.
System Installed by
a-00 �
1
Dat •
described above has been installed in compliance with
NO way be taken as a guarantee that the system will function
DAVIE COUNTY HEALTH DEPARTMENT
- IMPJROVEMENTS- PERMIT AND CERTIFICATE OF COMPLETION
*Note:_{ssued: in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
* Permit Number
Name
22-
�
�
Date r t �'
Location
Subdivision Name Lot No. Sec, or Block No.
Lot Size House Mobile Home Business w"Speculation---------.'
No. Bedrooms " No. Baths �� No: in Family
Garbage Disposal YES .p NO p-""
Specifications for System: ,
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES E] --NO E]if �Jf/�?1f /,%� - ' ` . /� t
' C
f"
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.-;
VF
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.
r
--• Final Installation Diagram: System Installed by
,1
Certificate of Comp tetion , J`/ x j` �t ' Date
a,
*The signing of this certificate shall in dicate-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.