167 Walt Wilson Rd O� �SY? rU.gip;" �-,,, ". .. '..•S. 't' ... ,5 ' � c - • ✓ X0
.1? DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND ,CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewag/e System/s� Permit Number
810LoName Date -4 N21 6810-
Location
cation <' ,l!� -,/J/ �'/� <, r-� "
._—
Subdivision Name Lot No. Sec. or Block No.
Lot Size—Q f y G House Mobile Home _ Business Speculation
No. Bedrooms _ No. Baths C2 No. in Family
Garbage Disposal YES ❑ NO ,moi Specifications for System:
Auto Dish Washer. YES NO ❑
Auto Wash Ma thine YES [ NO ❑ ����pX��, ��
Type Water Supply 1r
*This permit Void if sewage system described below is not ins filed-within-5-rears. .mr-nn date of issue.
This,permit is subject to revocation if site plans ort n ended 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
4-to
Q .
L.............................
Certificate of Completion Date t1II&P41),
*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 as a guarantee that the system will function
satisfactorily for any given period of time.
✓x0
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AWCERTIFICATE CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
- Sanitary Sewage Systems Permit Number
�i�rl,«'. r� , ,I A/'�` °i'r�'yJ If)u//i Date 1 NO
Name 6 8 1Q
Locations/T .� .y,.�/ IIJ-_
Subdivision Name Lot No. Sec. or Block No.
Lot Size House P' Mobile Home _ Business Speculation
No. Bedrooms—..�—.No. Baths C2 No. in Family
Garbage Disposal YES ❑ NO ,E�' Specifications for System:
Auto Dish Washer YES NO ❑
Auto Wash Ma.hin e YES ( 1 NO ❑
Type Water Supply
*This permit Void if sewage system described below is not insta,,,lJed.withiry years�f[l m date of issue.
M
This-permit is subject to revocation if site plans or t e- ended 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.
_J
Final Installation Diagram: System Installed by
c
/to
l
Certificate of Completion Date i!L
r _
"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.