386 Comanche Dr DAVIE COUNTY HEALTH DEPARTMENT
._ - . .
' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
"Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
f / Permit Number
Name !/��� C� /5'�/� Date
Location �r,.. .f J _ `�.�Ma,�44
Subdivision Name Lot Lot No. Sec. or Block No.
Lot Sized House Mobile Home — Business Speculation
No. Bedrooms — No. Baths No. in Family— —
Garbage Disposal YES ❑ NO ❑
Specifications for Syst
Auto Dish Washer YES C] NO ❑ e
yso X 3 X a ", � -Z'�
Auto Wash Machine YES p NO i❑
Type Water Supply _ 4:
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit by
"Contact a' sentativ the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M, or 1: :30 P.M. day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: �pi (fir System Installed by Do'o,%e- S iT c
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Certificate of Completion a, Date
'The signing of this certificate shall indicate that the system describ d 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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PAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57 �f r
MOCKSVI'LLE, K. C: 27028
(704) 654-5985
Statement for 'Septic 'Tan.k Improvement Permits
and/or Site Evaluations
NAME , /E/�' /S�J.�s/ DATE ISSUED
ADDRESS PERMIT N0. 42
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17
Explanation of charge
AMOUNT DUE_17V,
P SANITARIAN
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PLEASE.. REMIT THE ABOVE AMOUNT ON RECEIPT OF THIS STATEMENT.
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DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION , R1a3APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) e'I7
NAME kAo i1� �J 6 00 PHONE NUMBER q q- -;L e�q
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ADDRESS 3 2 G Le 11^dLv% �tf_T)r• SUBDIVISION NAME -11NA,o, �k'-W
A C�U- a-1 oe 1. LOT # /O
DIRECTIONS TO SITE E.,V- -k3 b,. \:?-J -
(no-RV \%o C w+— o%,N i-- Frt, T- ° U
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER Nltls ul—
TYPE FACILITY N4vu e- NUMBER BEDROOMS `{ NUMBER PEOPLE SERVED -3
TYPE WATER SUPPLY_g'ouh� SPECIFY PROBLEM OCCURRING Su r P�,�., c►� •�
DATE REQUESTED 1- 11-03 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
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.� DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
!/ Permit Number
Name /LICA-lS0 Al Date 5 X23 7
Location
Subdivision Name Lot No. /0 Sec. or Block No.
Lot Size L House Mobile Home _ Business _— Speculation
No. Bedrooms _ No. Baths —�z2—' No. in Family_l —
Garbage Disposal YES ❑ NO ❑ Specifications for Syste :
Auto Dish Washer YES E] NO E] Z/,r zq x 3 v�� �i�,� 7
Auto Wash Machine YES ❑ NO ❑ // - /�
Type Water Supply —r
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit by — �
*Contact a sentativ the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1: :30 P.M. day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: Cfa� Car System Installed by 5 .'T CD
S
-C ., $
�t 5e
Certificate of Completion '� Date ��✓� -7q
*The signing of this certificate shall indicate that the system describ d 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.