P7386 Farmington Rd 1:'v(�s-Fi� ..,L'y ..;;.. �r.ti'::ry,•y� ;�:91 �q.,L y .,. 4„• .. , ,...
'tMr''rlrPfSt"''.y;ES'''' !r eW '1": 'xY�"'t'aM'��t'YtL°Ypp���? S F'ti+` i• '� � it M�t^'��{`�1'T'ry.'.y �""ta`i.� y `. � q, - �.+riii "^F� ,, ..�,.
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DAVIE COUNTY HEALTH DEPARTMENT., so. a-o
1 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name Date N2 $ .
Location `>3 u �a v aw�p , N K7 60�-
LA
Subdivision Name Lot No. Sec. or Block No.
Lot Size House V Mobile Home.-- Businr's$._— Industry ,
No. Bedrooms No. Baths NR,,,in Family Public Assefnbly Other
Garbage Disposal YES p NO [ '``I �`t' "1�y
Specs tpations for System: _
Auto Dish Washer °� YES
Auto Wash Ma thine YES (g;- NO ❑
Type Water Supply
*This permit Void if sewage system described bel9w is not installed within 5,years from, of issue...,,.
This permit is subject to revocation if site plans or the intended use c�ange.
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.,
1:00-1:30 P.M.or 4:30-5:00 P.M.on day of completion.Telephone Number:704-634-5985.
Final Installation Diagram: System Installed byaa
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Certificate of Completion C Date
'The,signing of this certificate shall indicate that the system described above has been' lnstalied 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. Y r {
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DAVIE COUNTY HEALTH DEPARTMENTSZ�. o�
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
•,N&E.,Issbed iri Compliance With Article II of G.S.Chapter 130a
'Satlitary Sewage Systems Permit Number
pate ` 3 N2
7386
Location "(�'C �t ., v
- '
Subdivision Name Lot No. Sec. or Block No.
Lot \Size- � �• Houses— Mobile Home —T Business Industry
No. Bedrooms �- `^ v No Baths No;in Family�_ Public Assembly Other
�,Garbage Disposal,,, YES, ❑•• NO [y' t Specifications for System:. 1J 3
' Auto Dish Washer YES O.t"N� [9'
Auto Wash Ma:hive YES p- NO ❑ pyt"
Type Water Supply
*This permit Void if sewage system described below isnot installed w'thin S:years from date of issue.
This permit is subject to revocation if site plans or�the intended use Grange.
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y
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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., ti
1:00-1:30 P.M.or 4:30-5:00'P.M `on day of completion.Telephone Number:704634-5985. .
Final.Installation Diagram: System Instalied by a��2
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Certificate of Completion C Date
` "The signing of this`oeriificate'shall indicate that the system'described,!above••has been installed compliance with
the standards set forth"in the''above�repulation;-but,shall in NO way lie taken,as a guarantee'�that the system will function
satisfactonl foc'_en Non period of time.
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME °` S a PHONE NUMBER 4 y 5
ADDRESS 3 d SUBDIVISION NAME
vA LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLEDc1 `-� y NAME SYSTEM INSTALLED UNDER
TYPE FACILITY-A\ sp NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY C O`'" SPECIFY PROBLEM OCCURRING 51,
DATE REQUESTED INFORMATION TAKEN BY ��
This is to certify that the information provided is correct to the best of my knowledge,aDoat I understand Iam r ponsible for all charges Incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT /l
Rev.1/93