P2417 Madison RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Date22
,Location
Subdivision Name
Lot. Size
No. Bedrooms--='
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply,
*This permit Void
_ House
No. Baths --
YES C❑ NO ❑
YES ❑ NO ❑
YES ❑ NO 0
l
Lot No. Sec. or Block No
Mobile Home _ Business Speculation
_ No. in Family
Specifications for System:
sewage system described below is not installed within 36 months from date of issue.
, : 1, f ,';" i;/'•
Improvements permit by
*Contact a representative of t e Davie ounty Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day o completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by
Certificate of Completion
Dat
*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.
l�
, : 1, f ,';" i;/'•
Improvements permit by
*Contact a representative of t e Davie ounty Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day o completion. Telephone Number: 704-634-5985.
Final Installation Diagram:
System Installed by
Certificate of Completion
Dat
*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.
- - r DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name " .�'� / r �, Date %��// f. 2417
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home
No. Bedrooms --�� No. Baths No. in Family.
Garbage Disposal YES ❑ NO ❑ .+��`��
Auto Dish Washer YES ❑ NO ❑ •--
Auto Wash Machine YES ❑ NO C]
Type Water Supply r --� Business
__—
Speculation
Specifications for System:
*This permit Void 1f sewage system,describeb/low is not installed within 36 months from date of issue.
Z-
ell///;
J
Improvements permit by�t" /
*Contact a representative of toe Davieounty 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.
.;d i / /—
Final Installation Diagram:
System Installed by
Certificate of Completion Date
t
*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.