323 Wagner Rd (2) DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
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Name 7 S�`�.ti�,.�.- � `���� - Date No� _ 5937
Location _ R± (o �'1 xi 4-3
Subdivision Name Lot No. Sec. or Block No.
Lot Size D 5 �` House Mobile Home— . Business Speculation
No. Bedrooms No: Baths — No. in Family _
Garbage Disposal YES E] NO ['j Specifications 'for. System:
Auto Dish Washer. YES ❑ NO G/ I �"
Auto Wash Machine YES [`j NO ❑:,- 1 .5d )( '( } ��r .
Type Water Supply 1 __
*This permit Void if sewage system described below is not i stalled within 5 years from date of issue.
This permit is subject to revocation if site plans or the inte ded use change.
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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 enno��,-�,�, �Q
Certificate of Completion Date U_
'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.
x -DAVIE COUNTY HEALTH DEPARTMENT ��� "S'p,�U
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
_. 440Qf JI sued in Compliance With Article I I of G.S.Chapter 130a
,Sanitary Sewage Systems p\\ Permit;Number
Name 1 - r 0 NO 5937
er�.��-e-r, Date
T ^
Location _'Pt 6 dL 4 2'D %0 c`�.�
(,n
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No. Bedrooms ^ No: Baths __ No. in Family _
Garbage Disposal' YES ❑ y NO Specifications for System:
Auto,pish Washer YES ❑ NO
Auto Wash Machine,4" YES NO ❑ ! ✓v
Type Water, Supply yj
*This permit Void if sewage system described below is not i istalled within"5 years from date of issue.
This permit is subject to revocation if site plans or the inter ded use change.
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A
Improvements permit by
'Contact'a representat)1ve 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.
F}nail InsialJatiQn?Diagr m: -4 'A
System Installed by �S'
S o
f
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.
INFORMATION FOR SEPTIC
QSYSTEM REPAIR PERMIT
NAME �m AW �O t��- .S .A AARw 4wll% NUMBER
ADDRESS � SUBDIVISION NAME
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a
// SUBDIVISION LOT f
DIRECTIONS TO SITE __ •l9�� N \ \ b`c� .. __�' __
n Y
DATE SEPTIC SYSTEM INSTALLED
NAME SEPTIC SYSTEM ORIGINALLY INSTALLED UNDER
SPECIFY PROBLEMS THAT ARE OCCURRING
DATE REQUESTED 1 -� ' i b INFORMATION TAKEN BY �_�