2000 Farmington RdPermittpe's r% DAVIE COUNTY HEALTH DEPARTMENT
Name:
�1 Environmental Health Section PROPERTY INFORMATIONPJ(
P.O. Box 848 /"/ It%
Di,ections;) property: � ,� �1 `�� 1 %) / Mocksville, NC 27028 Subdivision Name:
01
AUTHORIZATION
Phone #: 336-751-8760
t r Section: Lot:
AUTHORIZATION FOR
WASTEWATER Tax Office PIN:# - -
SYSTEM CONSTRUCTION
AUTHORIZATION NO: z � A Road Name
**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior
to issuance of any �Buildirfg,Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections
Office when applying for Building Permits.
(In compliance, with �rtifle`.I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
i--.) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
IS VALID FOR A PERIOD OF FIVE YEARS.
ENVIRMN19NTALEIXftH'SPECIALIST JTE ISSUED
«_/
RESIDENTIAL SPECIFICATION: BUILDING TYPE Ab # BEDROOMS # BATHS 7 # OCCUPANTS-,Z�, GARBAGE DISPOSAL: Yes or No
COMMERCIIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No
LOTSIZE- /„\r" TYPEWATER SUPPLY,60A)7YDESIGN WASTEWATER FLOW (GPD) -- �%NEW SITE REPAIR SITE Z'A/
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH --I r ' ROCK DEPTH ,=" LINEAR FT. L�
�'�� I _
REQUIRED SITE MODIFICATIONS/CONDITIONS: �`�eut—
IMPROVEMENT PERMIT LAYOUT
/
C
i
Sri,�
h
lI) Tz T (-11/c.
11 FOR FINAL INSPECTIOWOF THIS SYSTEMPLEASt CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. 1
OPERATION PERMIT
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1 i%J F1 t-TAToK
QJIGCV- -Sl I> G qc�Msap"
-3 L.,l rj1
mcm 100'
SYSTEM INSTALLED BY:
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ems,
AUTHORIZATION NO. Zwk`— OPERATION PERMIT BY:
"THE ISSUANCE OF THIS OPERATION PE
WITH ARTICLE 11 OF G.S. CHAPTER 130A,
GUARANTEE THAT THE SYSTEM WU.Lr�
DCHD 02102 (Revised)
6.
AT THE S
AGEAND
ANY GIV
O
mcbA"J,61,
A Migo
ED ABOVE AS BEEN INSTALLED IN COMPLIANCE
,L SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
OF TIME.
Go,MAPS - Davie County NC Public Access
Page 1 of 1
http://maps.co.davie.nc.us/GoMaps/map/print.cfm?CFID=11225&CFTOKEN=54428949 1/2/2008
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