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162 Redland Rd - �rl Yw.y;�S".y.1 �fY+r p�'.'YIrS�'.rci�r,,l+ri"C_'C`�.Yea.: .�.i=i�d i..i'''rt'r�`.'.'el''��•..i" r.. ley b':. .7 n. R.4r i'F t Il' V t'+i.�x 1 .}P qL - * �` �' �•h DAVIE COUNTY HEALTH DEPARTMENT - IMPROVEMENTS .PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a Sanitary Sewage Sy tems Permit Number Name . Date �U 3 - y'' N0 7 7 4 4 Location �lG -�ij C= - � per, - �N� C?c� • -r,.A,. Subdivision Name Lot No. Sec. or Block No. Lot Size7 �''C House Mobile Home Businesps -- Industry. No. Bedrooms No.aBaths — 'z' No. in Family. — '_ Public Assembly Other Garbage Disposal YES"'p Or, Specifications fors System: '``'OE _ Auto Dish Washei YES Auto Wash Ma^hine YES ' ,NO*❑ Type Water Supply *This per it Void itsewage system described below;ws not installed within 5 years from date of issue. This per it is subject to revocation if site plans'or the untended se change., VJ •`111 i r r b k 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 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. 19. 70 •, ��' 10 DAVIE COUNTY .HEALTH DEPARTMENT �� ~ -� v 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 3 -29 N27744 Location'�� tom,N G. Q 0 o-1 rt Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business -- Industry No. Bedrooms .No. Baths No. in Family tl— — Public Assembly Other Garbage Disposal YES'❑ O — Specifications for System: _ Auto Dish Washer YESVN ❑ ) Auto Wash Ma thine YEStiOt ❑',.` } �' / 1,>1 U' �( ^ .3 t �' Type Water Supply �- ---- `This permit Void if'sewage system described bglow is not installed within 5 years from date of issue. This per it is subject to revocation if`site plans or the intendedse change. � r I Improvements permit by``--'� �+ s�s� "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:704634-5985. Final Installation Diagram: System Installed by j' Certificate of Completion �1� Date / �-/ 'The signing of this certificate shalyndicate 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 APP�QoTIIO�F�Oq IMPROVEMENT PERMIT(REPAIR) NAME e - ..ate PHONE NUMBER ADDRESS1 6, 1 ?1--,&2k - N�,c SUBDIVISION NAME �� V A�•N�Q LOT# DIRECTIONS TO SITE DATE SYSTEM INSTALLED 19 5 NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED �- TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING DATE REQUESTED I - 3 ' I 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 �wc Rev.1/93