P7120 Center St o.�. '..,yj.> di+"5::+:..aev iw r.✓"v^w w. �7,.;"+v%c.M ♦ ?.�;..,�,r�„rw':.+ y:ra.p saW"�"''ra-r .f.
DAVIE COUNTY HEALTH DEPARTMENT T ��
IMPROVEMENTS. PERMIT.AND CERTIFICATE OF.COMPLETION S o,oU
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
Sanitary Sewage Systems Permit Number
Name �I A N S d Date t N0 7120
Location Q•O' �3 9L° 7 v 114 6015
".x o s
Subdivision Name Lot No. Sec. or Block No.
Lot Size "" 'r House �� Mobile Home —T B4siness Speculation
No. Bedrooms ,<.No. Baths No. in Family — `"r :•
Garbage Disposal, YES C x,�-NO ❑ ' �`' , , �Spec ificationsr for System
Auto Dish Washer -; YES ❑ ,,NO,.._❑ ,t.,
Auto Wash Ma shine YES 5�r "NO ❑ ) S p !k Y 1�i
Type Water Supply C,o„”T3 --_
*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�� Na iNe.s
/
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—�
KJ
�J. M
... ` Ub.S
/ 1 - 9
Certdicate of Completion Date 5 a` 3
*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 betaken as a guarantee that.the system will function
satisfactorily for any given period of time.
s .. :.,•a —,c7: -r ..�..�w`t 7VY'a-" , ! Fr.., .r 'rT} •J.µ. TF,. / -:z. `.?� ,;.x ,�;1 .i b ,
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DAVIE COUNTY HEALTH DEPARTMENT 10 Y5
Ir
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a /
- Sanitary Sewage Systenis Prmit Number
Date NO 712
v ) u poi s
Location —
I` CYC
Subdivision Name -- - -- Lot No. Sec. or Block No.
Lot Size House Mobile Home Business -- Speculation
No. Bedrooms No. Baths No. in Family 'L —
Garbage Disposal , YES ❑ NO ❑ 1 -
Specifications for System: - -
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma thine YES Ef NO ❑ )
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.
a
,r,e.1
7s,z,
_ _..
C � _
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
ri 6 0S,:,
Certificate of Completion ` Date a - 93
'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.
'bads-
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION 4 p IA - W:�.-_
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME Eb/aYL- 0re-- PHONE NUMBER Rr,�
ADDRESS P� 'I"f 1, 0,D01eeYne-Q- c /014 SUBDIVISION NAME
LOT#
Y ,
DIRECTIONS TO SITE D f I' CI. ro/-- cc����• G
oft> ctA r Ouse- Lb C
k2 eu,—le—
DATE�SYSTEM INSTALLED d G1 YS_ NAME SYSTEM INSTALLED UNDER
TYPE FACILITY //U ��. NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRINGdZID
xi aq- 7us" A e- —d
DATE REQUESTED �9✓/ INFORMATION TAKEN BY `o
This is to certify that the Information provided is correct to the best of my knowledge,an at I understand I responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.1/93