1131 Wagner Rd (2) 01
a
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE, OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Syst s Permit Number
Name. ���, ���� — �,��v'.s�>,;,� ,�� Date ND
6922
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House ��Mobile Home _T Business Speculation
No. Bedrooms No. Baths No. in Family _
Garbage Disposal YES ❑ NO Specifications for System:
Auto Dish Washer YES ❑ NO ❑ � � / r _ Z
Auto Wash Ma^.hine YES p NO ❑ !/
Type Water Supply ? _
*This permit Void if sewage system described below is not installed within 5 years from date of issue:
This permit is subject to revocation if site plans or the intended use change.
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
dJ
Certificate of Completion _._ Date 421
'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.
• " DAVIE COUNTY HEALTH DEPARTMENT
- _ IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
*NOTE:'Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sewage Systems ; Permit Number
Name l 1;-� =_ �. 1�:� : s j= Date f �' '. N2,
Location 1
,/l/ /i'" / �� _�./ r.!/� ✓+ri,% f_.r.,%:s' �'J .moi...,-r/� / rl�. , :~
Subdivision Name Lot No. �' Sec. or Block No.
Lot Size House 1''"�Mobile Home Business - Speculation
No. Bedrooms t No. Baths No. in"Family
Garbage Disposal YES ❑ NO p— Specifications for System:
Auto Dish Washer YES NO j _
Auto Wash Ma.hine YES p NO ❑ f i `;
Type Water .Supply _--
'This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subject to revocation if site plans or the intended use change.
{
i
r
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
Jam/
l'
i
Certificate of Completion �} Date
"The signing of this certificate shall indicate that the system describ d 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.