975 Farmington Rd,.a,.-„v..,�� fir,w-.r+. ..,.,.m.r+�.��a,."6""W;erN.+nar.�.V SAV'Fi:1',o•!pa"ca .v„y+-yvr+-.-ter....•,;, r�+-w�►s•"+:..-s+..�e-v'r�'r-.�'�.•w�sa�, i�-sxv'V^R=r.-`^i%•Yara..4 -.�- .�s.,..y..i;,;.dt
DAVIE COUNTY HEALTH DEPARTMENT '�Q•
" 1� a.�ti� IAPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
' sarx�; a e Sys ams�5 0 �3 ” � Permit r
Name Date D No 72.76
Location �''� � `7 � '�U '�► o �\�.s v��\o, � �,, ��415 -
y
4.
Subdivision Name Lot No. Sec. or Block No.
57
Lot Size ;House Mobile Home —T Business'` Speculation
No. Bedrooms No. Baths No. in Family _
Garbage Disposal'" , YES p NO,[� 1U S�
Specifications for System:,
Auto Dish Washer._ YES °NQ.,[]
Auto Wash Ma^hine YES
=NQS , ^ _ �DO+ x 3 � � (��►
Type Water Supply ;t
*This permit Void if sewage system described below isnot installed within 5 years from date of issue.
This permit is subject to revocation if site plansaor the intended use change.
F
R
70
-7d'
o _
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.;_gn,day.:,of,.-completion: Telephone Number 704-634-5985.
Final Installation.Diagram: System Installed bye-ym k
70
Certificate of Completion Date �O
*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.
so. ob
DAVIE COUNTY HEALTH DEPARTMENT
r _ ` At�111PROVEMENTS PERMIT AND .CERTIFICATE OF COMPLETION 't
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
` '� Permit �`er
Sa ata_ry,SeW_4,,ge Systems �, (�- - i V
- - �� O
Name Date N_
Location
Jr/ 1,� c•� �' s.s��cs,:���\-;c'� � � T'..�_,.,� \r:--�s..*:z .. 1•J� .�s�.���:d`-2> ;��r.'.��_w,�'
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 ❑ NO
/ Specifications for System:
Auto Dish Washer YES NO ❑ �,�
Auto Wash Ma,.hine YES �i NO ❑ �7,�' / 1 "
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.
_ r
7 L)
� C
Tp
; P
� rf)
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.
• rte'
,Final Installation Diagram: System Installed by
7 j
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.
c DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
\ \ �A`PPLICCAATION FOR IMPROVEMENT,PERMIT(REPAIR)
NAME f� Ado` a J P CS PHONE NUMBER
ADDRESS SUBDIVISION NAME
---------
LOT#
DIRECTIONS TO SITE 01z\ N qzz� a
G(ZaQN �n�s2. — �c� S�y�e.R,S tjQ�oR.a. �e�Q�ho PQ �u� V�11�1�y
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY o °_5_ NUMBER BEDROOMS 2 NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
DATE REQUESTED �3 INFORMATION TAKEN
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.
SIGNATURE OF OWNER OR AUTHORIZED AGENT_.
Rev.1193