132 Equestrian Lane Lot 41 DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT PERMIT and OPERATION PERMIT '
IMPROVEMENT F.:RMIT
**NOTE** This improvement permit DOES NOT authorize the construction or
P P installation of a septic tank system or any was.ewater
sl :tem. AN AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to th?
^. :,;truction/installation of a system or the issuance -of a building permit.
(In cc r;ce with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
NAME �/ 1%�� PROPERTY ADDRESS ie_,e Z . —�%i i %I �-? 'n j : •i 5 DATE : <l
LOCATION {
SUBDIVISION NAME- /. LOT NUMBER SEC./BLOCK NUMBER l
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RESIDENTAL SPECIFICATION: BUILDING TYPE Apyy( # BEDROOMS � # BATHS # OCCUPANTS GARBAGE DISPOSAL- �No
COMMERCIAL SR:CIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes/No
LOT SIZE `� /%(. TYPE WATER SUPPLY DESIGN WASTEWATER FLOW (GPD) NEW SITE l,-"" REPAIR SITE
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SYSTEM SPECIFICATIONS: TANK SIZE,/�,,/'� GAL. RYP TANK 6AL. TRENCH WIDTH �"� , ROCK DEPTH � LINEAR FT. DTi
OTHER f' _
REQUIRED SITE MODIFICATIONS/CONDITIONS:
***THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTERWATER SYSTEM CONTRACTOR "'ST
SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM.
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IMPROVEMENT PERMIT BY _Z
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL INSPECTION OF THIS SYSTEM BETWEEN
8:30-9:30 A.M. OR 1:00-1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760.
SYSTEM INSTALLED BY J�,rv�s•>�1�•
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AUTHORIZATION NO. •. OPERATION PERMIT BY
DATE J A .I 7
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**THE ISSUP.MCCOF THIS OPERATION PERMIT SHALL INDICATE 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 7 SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.