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3091 Hwy 64E R ^rer.�s..�:.,.s-.�.,.,w..�,S4' raw.,-i`ws►awed-rn. > .�.. ..9.r- .- - wr -n a.: . ��;.;.c,.F, .�.,�-r...,.:i.«�a'.Wr-�! a t �: sr.."� _.'f" DAVIE tCOUNTY HEALTH DEPARTMENT IMPROVEMENTS.PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 1 pa Sanitary Sewage St Permit s �� t Permit Number Name �P NO 7 0 6 Location Subdivision Name Lot No. Sec. or Block No. Lot Size House / Mobile Home Business — Speculation No. Bedrooms 7 No. Baths _! No. in Family_�- Garbage Disposal YES p NO Specifications for System: Auto Dish Washer YES p NO �� Auto'Wash Ma^hine YES �O ❑' 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. co y p fr�i (� kit �s all Y It S ��W 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.:00-1:130 P.M. on day of completion. Telephone Number 704-634-5985. Final Installation Diagra'(m': System Installed by G Certificate of Completion G� 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 betaken as a guarantee that the system will function satisfactorily for any given period of time. }" 4 DAVIE COUNTY HEALTH DEPARTMENT `IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION _ *NOTE:Issued in Compliance With Article 11 of G.S.Chapter�]30a� Sanita7 Sewage Systems Permit Number Name _ _ Date O 7Z06 Location — .1 --i. - -Subdivision Name Lot No. Sec. or Block No. Lot Size House — Mobile Home _� Business -- Speculation i *No. Bedrooms No. Baths No. in Family Garbage,Disposal YES ❑ NO y Specifications for System: Auto Dish Washer YES NO 1l vG x� Auto Wash Ma shine YES E] NO © J 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. ce J4 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 1:00-1:00 P.M. on day of`completion. Telephone Number 704-634-5985. In Final Installation Diagram: System Installed by _ e t 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. DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) NAME , �/l��D.1/ �/JJ 1/ PHONE NUMBER ADDRESS �� SUBDIVISION NAME �D� 1/ /ices LOT# DIRECTIONS TO SITE GLC^ ^- !J✓(� B A) DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY �la _NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY 42eZe SPECIFY PROBLEM OCCURRING DATE REQUESTED 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. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev.1/93