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165 Turkeyfoot RdZ" 11 - SheAwta,14YJW Permittee' DAVIE COUNTY HEALTH DEPARTMENT Name: �A I Ilu 0 N i_ Environmental Health Section PROPERTY INFORMATION property: 4 w ' T. S)w P.O. Box 848 PA Directions to Mocksville, NC 27028 Subdivision Name: VIota • T 94 .CM 1t F Phone #: 336-751-8760 f Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - - 0 - T 'eked AUTHORIZATION NO: 002860 A Road Name: �i **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the bavie County Building Inspections Office when applying for Building Permits. (In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) AL HEALTH SPECIALIST ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION 45--s'.4 IS VALID FOR A PERIOD OF FIVE YEARS. DATE ISSUED __.Permittees DAVIE COUNTY HEALTH DEPARTMENT Name: N L- Directions to property: i f74 . 1u.)Vr,fo4 Pd - CA,It1r F f AUTHORIZATION NO: 002060 A Environmental Health Section P.O. Box 848 Mocksville, NC 27028 Phone #: 336-751-8760 AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION PROPERTY INFORMATII�ON !! Subdivision Name: "' 1 Section: Lot: Tax Office P'IIN::'# /� - - Road/Nae : / Zt ,eke,q Fa) � c; 170 **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance'of any Building Permits. This FornVAuthorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) 1' n _ ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION AL C - D� IS VALID FOR A PERIOD OF FIVE YEARS. ENIARONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No I tD 9 - COMMERCIAL SPECIFICATION: FACILITY TYPE PDQ 19T# PEOPLE . # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes ord9 LOT SIZE } - TYPE WATER SUPPLY CO • DESIGN WASTEWATER FLOW (GPD) Z S-1> NEW SITE REPAIR SITE 16� SYSTEM SPECIFICATIONS: TANK SIZE E04N GAL. PUMP TANK Nib" GAL. TRENCH WIDTH 1 ed ROCK DEPTH I d'r LINEAR FT. 2-9 1 1 t(n 4&4 11- - . A 1 OTHER _ i�MleL dF 2S 40r -t^ i1c0 (U`apir F $ o46. bld- w1.S4nK 4-A,"j Q %% civ b•- CVL -- REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT C1 X 2 4 X tt Raa:.K -41V ost 0j 5l O Lid S s� —rrat stub t, 01%3ED tg� a ��1ja 7� FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT SYSTEM INSTALLED BY: J N' AUTHORIZATION NO. Z910'D OPERATION PE BY:Fq^3� DATE: **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICA AT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 07!02 (Revised) Perrrittee 5. ; DAVIE COUNTY HEALTH DEPARTMENT N Name:.. F)01 1 ;l r? 11 Environmental Health Section PROPERTY INFORMATION P.O. Box 848 Directions to property: f' tt '.,t 1 1• I (qtr°' Mocksville, NC 27028 Subdivision Name: 1, n a Phone #: 336-751-8760 t�,E;' `t ,� ,; ,•;) r - �. (� Section: Lot: AUTHORIZATION FOR • WASTEWATER Tax Office PIN:# SYSTEM CONSTRUCTION - f r AUTHORIZATION NO: OUCH A Road Name: **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Pennits. (In compliance with Article I 1 of G.S. Chapter 130A, Wastewater Systems, Section. 1900 Sewage Treatment and Disposal Systems) ' _ ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION q`l,^ jl 0, Z) .* 0z IS VALID FOR A PERIOD OF FIVE YEARS. ENV RONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS w # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE T# PEOPLE # PEOPLE/SHIFT t`% #SEATS—Ayr r INDUSTRIAL WASTE: Yes or LOT SIZE ZS 4 TYPE WATER SUPPLY rQ • DESIGN WASTEWATER FLOW (GPD) Z- ! D NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE E T-SiGAL. PUMP TANK NI r GAL. TRENCH WIDTH 1"t, ROCK DEPTH 1 / LINEAR FT. - 1 11 t1,1 OTHER (UM,kQ (1)1nPA-1 S AIV— hl -(l• IS411 Aral) C;11 REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT Q y, FEZ, tam �( A,Y) � � � �,•. btu, �<�, '"�\,� G��t2k FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT ' SYSTEM INSTALLED BY: 4 ( I .y ♦ �� 1 -� AUTHORIZATION NO. 2-96Z) OPERATION PE IT / /� DATE: 57 — — cl - O Y "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICAT THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. 6MD 02/02 (Revised) Permlttee's'= Name: Directions to property: ,DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION P.O. Box 848 " Mocksville, NC 27028 Subdivision Name: 1 `' Phone #: 336-751-8760 Section: Lot: AUTHORIZATION FOR WASTEWATER Tax Office PIN:# _ SYSTEM CONSTRUCTION r - AUTHORIZATION NO: 002,P360 A Road Name: ' Zl� **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENV RONMENTAL HEALTH SPECIALIST DATE ISSUED RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS ' , # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE Pbj i # PEOPLE Ar # PEOPLE/SHIFT iC� # SEATS INDUSTRIAL WASTE: Yes or tfo� LOT SIZEt > l • TYPE WATER SUPPLY r�) DESIGN WASTEWATER FLOW (GPD) �' `� NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE 1'-I 4 GAL. PUMP TANK t i� rt GAL. TRENCH WIDTH JI �:'. i ROCK DEPTH i i! / LINEAR FT. OTHER !ll( '"VV,�` REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT 12't� 17. FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. OPERATION PERMIT r SYSTEM INSTALLED r AUTHORIZATION NO. 7 �` ( OPERATION PERMIT BY: ' \ "" DATE: i "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATES AT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME. DCHD 02/02 (Revised) w�- y►ti 8- - Z ;w i7 -sures Off j4F#ZAt- DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION %APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) (� NAME ,\ ��iC�� Rl�t/" l-. f'QIIL� 6he PHONE NUMBER ADDRESS /Gs- SUBDIVISION NAME A4nJ144-; /iG ✓l L Z 7d Z�- LOT # DIRECTIONS TO SITE 64 bJ- - T 1 . IR fw W DATE SYSTEM INSTALLED d NAME SYSTEM INSTALLED UNDER 9�^ TYPE FACILITY 9Q W -D NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY LPJU SPECIFY PROBLEM OCCURRING li hhr�1 6'u� DATE REQUESTED 5- S -Dy INFORMATION TAKEN BYQI� This is to certify that the information provided is correct to the best of my knowledge, aNd that I understand Iprrrrlesponsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AG fiev. 1/93