146 Hobson Dr ai,�":.v+:.v-:r.qr'.wr;l`�•'Ws�`�,"ib..rdwwtig.--.,swvr •c'rY-'ti-"i4+r-`;h-' '-ro.�;+.c+rs, a.:-r�.�r"+.zw:'+Ei++u+."'^.,..qsv^v"y.�',�'::�.a�`�.+`v�•�tiacus.w.+.!*'+,.ary;t'+�,
t DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE. OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Saniary Se�age/Systems Permit Number
Name�flC!�r 1131��f14ry Date ��y��� No
-,f 'r o 7 .94
Location dSs— o..r��
i-lad ®%�
Subdivision Name 4) 0 - r Lot No. Sec. or Block No
Lot Size Nouse �� Mobile Home — Business — Speculation
No. Bedrooms No. Baths No. in Family -2-
Garbage
Garbage Disposal AYES. ❑ NO ❑ ¢.Specifications for System:
Auto Dish Washer YES ❑ NO ❑ i
Auto Wash Ma:hive YES NO ❑
Type Water Supply — ---
*This permit Void if seyvage�yIstem described below is not installed within 5 years from date of issue.
This permit is subje&to.r'ev�ation if site plans or the intended 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 � � r
5
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: ''
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
--NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
ani ary Sewage Systems Permit Number
J�r ,c >� 9 4'"Name '� �� r����v���'_1/. Date No 71
LocationJR -A--I
i 1
Subdivision Name s "���1f� C T Lot No. Sec. or Block No.
Lot Size House �� Mobile Home _ _ Business __ Speculation
No. Bedrooms ,No. Baths — No. in Family _
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑ f %.ry (/� �-� � �y.
Auto Wash Ma thine YES� NO ❑ „
Type Water Supply __— At,
*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 of the intended use change.
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.--"Improvements permit by
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'Contact a representative of the Davie County Health:Department ar final in speµcfion of thms system between 8:30-
9:30 A.M. or 1:00;1:30 P.M. on day of completiort!,Telephon Number 704-634-5985.
Final lnstallatiot? Diagram: System Installed b
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Certificate of Completion (' Date 217195
'The signing of this certificate shall indicate that-the_system describedabove 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.
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
• QAPPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME � ��XL') PHONE NUMBER
ADDRESS '� D SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE i`✓C' ,C/P N yl r
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY /r e NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY—4 SPECIFY PROBLEM OCCURRING
DATE REQUESTED_6 �/ INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge,and that I understand I am responsible for all charges incurred from this application.
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SIGNATURE OF OWNER OR AUTHORIZED AGENT �Nf L `
Rev.1/93