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180 Hunt St (3)**NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior/ to issuance of any Building Permits. This Form/Authoriaation Number should be presented to the Davie CountyBuilding Inspections/ Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A; Wastewater Systems, Section.] 900 Sewage Treatment and Disposal Systems) �" ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. -ENVIYtON , LHEAI< H'SOECI LISifs DATE.IS ED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY; 1T -v DESIGN WASTEWATER FLOW (GPD) NEW SITE - REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZEGAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH `� LINEAR FT. OTHER 1—: iS•TK �t��l REQUIRED SITE MODIFICATIONS/CONDITIONS: Perrrvreee's D VIE COUNTY HEALTH DEPARTMENT _5 Environmental Health Section PROPERTY INFORMATION Directions to property: P.O. Box 848 Mocksville, NC 27028 Subdivision Name: jjrrf Phone #: 336-751-8760 Section: Lot: �^; r �'+t���,�,.� AUTHORIZATION FORw WASTEWATER Tax Office PIN:# --s AUTHORIZATION NO: A SYSTEM CONSTRUCTION Road Name: 1" W1 .21 : r l V7 **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior/ to issuance of any Building Permits. This Form/Authoriaation Number should be presented to the Davie CountyBuilding Inspections/ Office when applying for Building Permits. (In compliance with Article 11 of G.S. Chapter 130A; Wastewater Systems, Section.] 900 Sewage Treatment and Disposal Systems) �" ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. -ENVIYtON , LHEAI< H'SOECI LISifs DATE.IS ED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY; 1T -v DESIGN WASTEWATER FLOW (GPD) NEW SITE - REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZEGAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH `� LINEAR FT. OTHER 1—: iS•TK �t��l REQUIRED SITE MODIFICATIONS/CONDITIONS: `.'Pee's,. _) / 1 D ,VIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION`S P.O. Box 848 Directions to property:`"~ Mocksville, NG 27028 Subdivision Name: Phone #: 336-751-8760 tt Section: Lot: 1 i AUTHORIZATION FOR R" WAST WATER SYSTEM CONSTRUCTIONTax Office PIN:#^ AUTHORIZATION NO: A Road Name n 1-,,, e Z p: # 'r, **NOTE""* This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior` to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance' With�Article 11 of G.S. Chapter 130A,- Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ,.***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION �. L) •.=� IS VALID FOR A PERIOD OF FIVE YEARS., "^^ENVIRONMEt4-fAL.HEAL••"SPECIALIST'..; • `DATE IS ED. RESIDENTIAL SPECIFICATION: BUILDING TYPE �� # BEDROOMS # BATHS '""` # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No ^A" c LOT SIZE- TYPE WATER SUPPLY ' DESIGN WASTEWATER FLOW (GPD) D NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTHt' ROCK DEPTH LINEAR F -r. 1 u OTHER. "► •° a REQUIRE � � ~: - h 1. V D SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT i ... I Vii:.. **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 THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. r SYSTEM INSTALLED BY: �,,,� ��- x ,� X1 Z' (rJt)T C,.)rAiLV-T G &Srucr,, 5,0, 1 Lxt �T h U AUTHORIZATION NO" —';'Z 7 b OPERATION PERMIT BY: :H0 lei JJ V DATE: J 3 -a **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY, BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02 (Revised) 9.. , Po (1A q � s .. . 16 r98p (1531 7 CO a e� �u� • 70 i "-,440 0 a X4149,454.' 8 (92 3 �� _, �� � 9,454 ` 7461 � (2.45A) �`� 5481 �q� r �� K S 6 ` o T ti. 7? 1 1402 � - ,m. 634 F7�: N ° �4 4336 �� 7g � 097 7305 n 8331' 7 a ` 1 4215423 1S 0212 r 6,129 a f186 �ls F r i 2a ..9;� 4 o l a2 5: 4 1 2082 r; ��... . © ry 103' n • ... � � 5476 q20 • r, vaf. 2941 6962 7942 . 68 IY '7 88b7 9865 19 0833 7970 1 ' v (1.42A) ��76 X769 , o he lk 1800 1,91 co 1705 �Oo `� ���3� �5 7753 , 013 <5 0 czCO 23 2 ry 6 (1.73A) 5631 t `� CO v ,. 7 � 7515 9593 26 � 791 � 94 (6p0) J 16A, �2>4A F � 6400 5 a I I LiO I Permittee 's j DAVIE COUNTY HEALTH DEPARTMENT Name:`-�`�"�'''~L'� Environmental Health Section PROPERTY INFORMATION P.O. Box 848 Directions to property: N • ��►� S� Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 Section: Lot: AUTHORI7,ATION FOR WASTEWATER Tax Office PIN:# r� n2 SYSTEM CONSTRUCTION LName AUTHORIZATION NO: ARoad Name:b� 'Lip: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Pen -nits. This Fonn/Authorization Number should be presented to the Davie County Building Inspections Office when applyingfo Building Pennits. (In compliance w}{b_,�Lrtick-l.�of . C per . Wastewater Systems. Section. 19(X) Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ON SPECIA IST UA I; IS UED RESIDENTIAL SPECIFICATION: BUILDING TYPE liQi5F—# BEDROOMS 2 # BATHS # OCCUPANTS 2 GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFTlf' j�� # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE %� ' �C TYPE WATER SUPPLY b ry DESIGN WASTEWATER FLOW (GPD) � v NEW SITE REPAIR SITE 1 � r SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUnMPTANK GAL. TRENCH WIDTH ROCK DEPTH 12r LINEAR FT. 100 OTHER l St R 1 +gt7Tlt�.i ?>C)>4— REQUIRED SITE MODIFICATIONS/CONDITIONS: u IMPROVEMENT PERMIT LAYOUT XU9-\!CANNNTtoc.,� oF "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 THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. [OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. OPERATION PERMIT BY: DATE: •'THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE l I OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02 (Revised) • Permittee' s D)AVIE COUNTY HEALTH DEPARTMENT Name: U MVV L Environmental Health Section PROPERTY INFORMATION 1-1-T- P.O. Box 848 Directions to property: rVk�� —� trj Mocksville. NC 27028 Subdivision Name: Phone #: 336-751-8760 Section: AUTHORIZATION FOR --�'�`-� WASTEWATER Tax Office PIN:#_ r-6 S-11.14 CONSTRUCTION AUTHORIZATION NO: rr�� G 8 A 23 Road Name: Lot: OOT S 0' 02 **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 1 I of G.S. Chapter 130A. Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. TE RESIDENTIAL SPECIFICATION: BUILDING TYPE I # BEDROOMS �z # BATHS # OCCUPANTS 2 GARBAGE DISPOSAL: Yes or No COMMERCIAL S SP�E•CIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT il # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY i DESIGN WASTEWATER FLOW (GPD) L p NEW SITE REPAIR SITE j i - SYSTEM SPECIFICATIONS: 'TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH `Z- LINEAR FT. OTHER r �t l ISI a L1 rjO.J jC REQUIRED SITE MODIFICATIONS/CONDITIONS: �C5� IMPROVEMENT PERMIT LAYOUT ,1Qa_3c_ gad" �I Z G 1-,talio ty� �tSTI� "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 THE DAY OF INSTALLATION. TELEPHONE # IS (336)751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: AUTHORIZATION NO. _�� OPERATION PERMIT BY: DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02 (Revised) r;I