1119 Wagner Rd X
DAVIE COUNTY HEALTH DEPARTMENT
S IMPROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary, ewage Systems / Permit Number
Nam e� �P /� ��! ���s SC/�r..,J Date NO
6825
// r�,f�� ,EJB o '
Locatio ri _
Subdivision Name Lot No. Sec. or Block No.
Lot Size House ✓ Mobile Home _T Business Speculation
No. Bedrooms (=Q .No. Baths No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑ ,�,
Auto Wash Ma^hine YES ❑ NO,❑ /-i7le'ynlr
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.
e
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\ !/'Yj2/d�t�'�/diori✓L
Certificate of Completion 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.
Xa
a"
DAVIE COUNTY HEALTH DEPARTMENT
== IMPROVEMENTS PERMIT AWCERTIFICATE CERTIFICATE OF COMPLETION
*NOTE:'Issued in Compliance With Article I I of G.S.Chapter 130a
-Sanitary Sewage Systems Permit Number
Name %. Date �5�'
Location 21,
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Ho a _'Business __ Speculation
ti
No. Bedrooms No. Baths 'No. in Family _ -h
Garbage Disposal YE ❑ NO ❑
Specifications for System: .
Auto Dish Washer YES ❑ NO ❑ „
Auto Wash`Ma,hine YES ❑ NO_ ❑
Type Water Supply _
'This,permit Void if sewage system described below i not installed within 5 years from date of issue.
This'permit is subject to revocation if site pans he intended use change.
�M
1 /
' Improvements permit by —4 /
t '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` >i/L` (��,",
4 Cerfificate,of Completion Date
'The signing of this certificate shall indicatethat-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.