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1629 Underpass Road Lot 1DAVIE COUNTY; HEALTH DEPARTMENT- -IMPROVEMENTS PERMIT AND, CERTIFICATE OF COMPLETION •NOTE: Issued in Compliance With Article II of G.S. q, apter 130a :} Sanitary Sewage Systems jPermit Number Name �J�s�.! ..11a% f�� Date, s1 A2 7917 Location Q11KAivicinn Ahmn lz lljf Lot No. Sec. or Block No. a DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE: Issued in Compliance With Article I I of G.S. Chapter 130a Sanitary Sewage Systems Permit Number Name -2�1f . ,f,'% i' Date "J- N2 7 917 Location '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. ' r\ lid; I ; ; y , Vea) l --------- -'------- - - -- <0 e 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.,—/6c) Final Installation Diagram: System Installed by Certificate of Completion �_ ��\t'� __ 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. Subdivision Name Lot No. Sec. or Block No. Lot Size ------ House —L---'� Mobile Home ---_ Business -- Industryy No. Bedrooms "--.No. Baths - ! — No. in Family _�— Public Assembly Other Garbage Disposal YES ❑ NO p-. Specifications for System: _ Auto Dish Washer YES �NO ❑ r Auto Wash Ma^hine YES NO ❑ /J`��,i ->" - ��k` f 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. ' r\ lid; I ; ; y , Vea) l --------- -'------- - - -- <0 e 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.,—/6c) Final Installation Diagram: System Installed by Certificate of Completion �_ ��\t'� __ 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. DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption Sewage Disposa System - G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR `� •I i i �'` + 1*: i.. r 6 DATE "'' PERMIT LOCATION C..` • i �' .� i 1 w,�': 0."' SUBDIVISION NAME S. R. NO. LOT NO. SECTION OR BLOCK NO. HOUSE p'" MOBILE HOME p BUSINESS ❑ ,oNO. BEDROOMS BATHROOMS GARBAGE DISPOSAL UNIT YES 0 AUTO. DISHWASHER YES�NO ❑ AUTO. WASH. MACHINE YES NO ❑ SITE SUITABLE YES ©'",J 0j rA"I SIZE OF TANK ' Ir , gal. NITRIFICATION FIELDf"t-�,,� iii } sq. ft.` DEPTH OF STONE IN LINES: WATER SUPPLY: Individual E`' P blic ❑ IMPROVEMENTS PERMIT BYIf �f AGO House Trailer 800 Gal. 400 Sq. Ft. Two Bedroom House 800 Gal. 600 Sq. Ft. Three Bedroom House 900 Gal. 900 Sq. Ft. Four Bedroom House 1000 Gal. 1200 Sq. Ft. is INSTALLED BY F,. CERTIFICATE OF COMPLETION By tit `�-- --��,� Date " r (8/16/73) *Construction must compli'with all other applicable State and local regulations LOT AREA + 1 / I- -* r / � u, ,,� r DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) NAME 41-e L_5 �� 17 PHONE NUMBER'%D % ADDR DIRECTIONS TO SITE BDIVISION NAME LOT # Q DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY l n SPECIFY PROBLEM OCCURRING DATE REQUESTED /�� INFORMATION TAKEN BY .4,&, This is to certify that the information provided is correct to the best of my knowledge, and th I understand I m spo Bible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGEN Rev.1193