P6435 Walt Wilson Rd "p DAVIE COUNTY HEALTH DEPARTMENT r f1
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems `y.. z� Permit Number
- Iv - No ,7.V.
Namey.. ���a�� A�-�� , /c,- ���c�. Date 5
Location 6o/S - T. 72•% Lv
Subdivision Name Lot No. Sec. or Block No.
Lot Size 2 7 House Mobile Home _— Business Speculation
No. Bedrooms No. Baths No. in Family r2 _
Garbage Disposal YES ❑ NO p, Specifications for System:
Auto Dish Washer YES ®ANO p
Auto-Wash Ma.hine YES E�, NO ❑
Type Water Supply _C'frz.,
`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
IID
r t✓ �,
Certificate of Completions`' �:7�, Date
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.