196 Laird Rd ...�..,°,�i"v*�zr"-`.:..-aw 4i1'vr.W. ::L;:.r:wi � „�yr+�..'ox'.taa i'+w.+7 :'v i.' s"'i+"..-.. =n�.;k-, .z,+,....._. ,i_' - r-•'.,, -r .r T y ,,
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
".NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
anitary Sewage ystems Permit Number
Name N—� 1 p Ss� tJ Date N27683
Location �� O) �u 'P•Nc l2 \ `+ �U
Off-,
Subdivision Name Lot No. Sec. or Block No.
Lot Size 09 House Mobile Home Business -- Industry ''
,�*t , , a
No. Bedrooms fib. Bath' r� No. in Family_ Public Assembly Other
s
Garbage Disposal YEt ❑ t NQ >t f:, Spe�Cif* t'*ns_fob' to k' .r
Auto Dish Washef YES;❑ NO 0''«"a:..�rSs ' �;, '� S
,' C)0.J t
Auto Wash Ma:hi a c, �YES�
941
Type Water Supply
*This permit Void if sewage;system described below is not installed \4ithin 5;years from date of issue.
This permit is subject td',revocatiq,n if site plans or the intended use change:;.
Z
O�
ty. ,
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 by
9Y
Certificate of Completion � � Date L�J f
*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.
"✓_ID+ r A is
r
40
yah. DAVIE COUNTY HEALTH DEPARTMENT �'�
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
{ I a � NOTE Issued in Compliance With Article I I of G.S.Chapter 130a
anitary Sewage Systems Permi
t Number
Name—_ —N_� ► q Sca N _ Date rd � ' t�' N2 t 6 8 3
Location �7 \ V '�4ac �"� - I '
.� � E L*t�+ �� 1` � OS3.•b �i.tiA ���`3J.1 y.,y-• �r .Ja•J�-a �AVS:szL�i t.•�a���•�,
Subdivision'Nam1e Lot No. Sec. or Block No.
Lot Size ( ra` House Mobile Home _T Business _— Industry r
No. Bedrooms '`` � �Nb. Baths`" � ,t '} No. in Family _ Public Assembly Other
Garbage Disposal YE `', ❑ NO C5'- S ec fa�a •�i i ns for S to
Auto Dish Washer; YES.❑ NO L�"' p � 'g4�x
Auto Wash Ma^hine '-YES [�'•NO ❑ ov t J 1 /i Y ,g''�i�az
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"revocatioQ if site plans or the intended use change.`
r
g
`•gs>
Q YN(\.q,
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 by
s�
Certificate of Completion Date �^y� 9
*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 oYime.
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION �' •3 1 u °
` APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME PHONE NUMBER '� Cl
ADDRESS \��� �� SUBDIVISION NAME
LOT#
DIRECTIONS TO SITE
v
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY V\ `n°p NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY 1,,< SPECIFY PROBLEM OCCURRING
40
DATE REQUESTED ' ��� INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledg , that u d glen���mjresoable for all charges Incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.1/93