P31571'
DAVIE COUNTY HEALTH DEPARTMENT
+ti
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Nate: Issued in ompliance with G.S. of North Carolina Chapter 130—Article 13c.
Name
Location
Permit Number
r Date
Subdivision Nam6 Lot No. Sec. or Block No
Lot Size House ' '` Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family _
Garbage Dispose I YES ❑ NO ❑ ` Specifications for. System:
Auto Dish Washer YES E]NO E]
Auto Wash Mach ne YES 0 NO
Type Water Sup ly _
*This permit Void if sewage' system described below is not installed within 36 months from date of issue.
Improvements permit by
*Contact a repr sentative 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:
*The signing of
the standards s
satisfactorily foi
nstalled by
Certificate of Completion Date j
,iis certificate shall indicate that the system described above has been installed in compliance with
t forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
any given period of time.
/ 1
V
'NJ te: Issued in
Name \ r .
Location
Subdivision Na
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION.
Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Date
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 Wash r YES p NO ❑ �;� . ,. , ,, �e� - ,y f"
Auto Wash Machine YES NO ❑
Type Water Supply
f
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by j
*Contact a rep esentative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or :00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installatidn Diagram:
Installed by
P/moiCertificate of Completion Date
*The signing cf 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 or any given period of time.