126 Lagle Ln DAVIE COUNTY HEALTH DEPARTMENT
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IMPROVEMENTS,PERMIT AND .CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130at}
Sanitary Sewage Systems _ Permit Ndmber
Name �.R `. n c ate y 9 No
5� e.
Location 7 7
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ ✓ Business Speculation
No. Bedrooms ;No. Baths 2 No. in Family
Garbage Disposal "'1YES,❑ .. NO [)� ; , Specifications for System: A
Auto Dish Washer YES ❑ NO [gam k 3 0 16 T
Auto Wash Ma.hine YES W NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This.permitis subject to revocation if site plans or the intended use change.
S
CSI" 4-
617"
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
V
S S aJ
Certificate of CompletionDate 5 L� 92)
"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 betaken as a guarantee that the system will function
satisfactorily for any given period of time.