P7848 Underpass Rd C9,
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Sew!ge Systems Permit Number
Name_� >Ly �O _Date /�/1�9� NO 7848
Location
x2 r
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _—__ Business —_ Industry
No. Bedrooms _.No..Baths — No. in Family Z _ Public Assembly Other
Garbage Disposal YES p NO p- Specifications for System:
Auto Dish Washer YES NO F) y V
Auto Wash Ma^hine YES NO
Type Water Supply 11
'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
'ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
t,9T
Tn
c.
7s'
Improvements permit by
—r
*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.
_ Y
- - ..... ,..,+.;:::, ,-,-.,,s. +.i�.:,..-.-•4.-e. - �_� `y.xt w ..,.,. .. �`t,. a.�,....s x r 5;1�-. r.. ^.,"' ,Y _-'!� < •a, _. i`0 r --_
� -- t DAVIE COUNTY HEALTH DEPARTMENT —~
%IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 1
'NOTE:-Issued in Compliance With Article II of G.S.Chapter 130a
Sanitary Setage Systems Permit Number
Name y�r;i t.. / I i. -- Date "/ %`� NO 7848
Location / 1 r "�'f 7 /
Subdivision Name Lot No. Sec. or Block No.
Lot Size -- — House _ Mobile Home ---- Business -- Industry
No. Bedrooms=' 3—.No. Baths — — No. in Family— Public Assembly Other
Garbage Disposal YES ❑ NO Q' Specifications for System:
Auto Dish Washer YES U NO ❑
Auto Wash Ma-hive YES NO
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
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM.
O
J
e,i` i
v� r
-7, L
------------
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 �c� - 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 wilj,function
satisfactorily for any given periodof time.
` DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOB IMPROVE NT PERMIT(REPAIR)
NAME 141 `� Sv se°n PHONE NUMBER
ADDRESS SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE �ST �1�r� Grp ��� _��'✓ �;�� �Pi, r�
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED J
TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING
e
DATE REQUESTED INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge,and that I unders Is res bl ll charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.11W