232 Walt Wilson Rd -= DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
~`NOTE: Issued in Compliance with G.S. of North Carolina Chapter 130 Article 13c
Sewage Treatment/and Disposal Rules (10 NCAC 10A .193 - 1968) Permit Number
Name ,f% .,; F Date � ;� ,�,. <lr 3"OA
Location /`: L /�- / �V
Subdivision Name Lot No. Sec. or Block No.
Lot Size �` %' v' t=� House Mobile Home �-' Business Speculation
No. Bedrooms _ No. Baths, No. in Family _
Garbage Disposal YES ❑ NO,p "
Specifications for System: ..
Auto Dish Washer YES p NO ❑ ,/ �'G,' r%F r..� '"�--~`' '
Auto Wash Machine YES Ej NO ❑ �„
Type Water Supply "X/. '-/ _ — -
`This permit Void if sewage system describ�d b low is not installed within 36 months from d to of is 4e.
1
Improvements permit by _! r
*Contact a representative of the Davie County Healt Depa tment for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion Telep one Number: 704-634-5985.
Final Installation Diagram: �ystem Installed by
Certificate of Completion _.� /x`�-�� 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.