P2646DAVIE 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 Date 04
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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.
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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.
Final Installation Diagram: System Installed by
Certificate of of Completion Date
*The signing of this certificate shall indicate that the system described ab ve 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 ~,
���P����VE��ENTS PERMIT AND CERTIFICATE OF COMPLETION
°Note]oouod in Compliance with G.S. of North Carolina Chapter 130—Article 13o.
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Permit Number
Name Date
Location
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Subdivision Name
Lot No. Sec. or Block No
Lot Size Gize Houoe Mobile Hnme-_-_--_-_ Business ___------Speculation _---__--_
No. Bedrooms No. Baths No. in Fami|y-___----_
Garbage Disposal YES :E] NC>0~~�
Specifications for System:
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Auto OiahVVaoher YES [] N
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Auto VVanhK4ochino YES [�-.."O E]
Type Water Supply
*This permit Void if sewage system described below � .
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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: 704-634-5585.
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Final Installation Diagram: System Installedbv
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Certificate ofCompletion
'The signing of this certificate uhoU 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.