191 Westridge Road Lot 23w ^ --�� . ..�++�3�, Y�.�""+i�0`DY✓�'ra� � ` .;i'" r� `ai��* , y'..�:.�^Fi".�:a'.c. _. `." „� I /'
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I a. w` DAVIE COUNTY'NEALTH DEPARTMENT
"IMPROVEMENTS PERMIT AND -CERTIFICATE OF COMPLETION ku
*NOTE` Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
Name �,� e2eeK'_.,O� rAzwf% Date N2 C 36-0'
Locatior,�.�e
Subdivision. Name Lot No.
- Sec. or Block No.
Lot,Size House e.. ---r Mobile Home _T Business Speculation
No. BedroomsNo. Baths No. in Family. N
Garbage Disposal YES, ❑ NO ❑ Specifications for System:
Auto Dish Washer. YES ❑ NO ❑
Auto Wash'Ma .kine YES ❑ NO ❑ �sr�k-�X/o7 �"`(.
Type Water Supply _
*This,perm it/Void if sewage system,described below isnot in talled within 5 years from date of issue.
This'permit is�subject to revocation "if site.plans or the inten d use change.
r
Idly
r
r,
mprovements permit by —
*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 day of completion. Telephone Number 704-634=5985.
1- i
.s.
Final Installation Diagram: 9 �,� Systemdnstalled by
F VA
Certificate of Completion C?r`� Date% - 9
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 betaken as a guarantee that tfie s stem will - •
satisfactorily for any given period of -time. Y II function
DAVIE COUNTY HEALTH DEPARTMENT
- IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION"=�
*NOTEi Issued in Compliance With Article II of G.S. Chapter 130a
',Sanitary Sewage Systems Permit Number
Name _�,;, t"":/ 3 _ Date
N- 0
Location
Subdivision Name '�`` �!-'
��� �'
Lot No.Sec. or Block No.
Lot Size
House
Mobile Home — J Business -- Speculation
No. Bedrooms –��
No. Baths— �>
No. in Family —
Garbage Disposal
YES ❑
NO ❑
Specifications for System:
Auto Dish Washer
YES ❑
NO ❑
• , '� c
Auto Wash Ma .hine
YES ❑
NO ❑
f .� :��,%ci :=»�
� r
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.
J
--,------"–l`mprovements permit by
*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 day of completion. Telephone Nrber 704-634-5985.
Final Installation Diagram: System installed by
�f tib - <'� �c,
1• ,/� /' /��. ✓ � —�-- -
JX
co F --
Certificate of Completion ` �,� Date - 9 I
"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) Lnprovements Permit and Certificate of Completion
(Ground Absorption Sewage -Disposal System - G.S. Chapter 130 -Article 13C)
OWNER OR CONTRACTOR V i-,(: %i DATE / ,',, ' jr .7 PERMIT
LOCATION{.
f ,. N� 1'718
� � '. ,•• > � ' : , � • , •. _ � .- .
S.R. NO.
SUBDIVISION NAME ' `"" '°` LOT NO. SECTION OR BLOCK NO.
HOUSE U" MOBILE HOME U BUSINESS U
NO. BEDROOMS NO. BATHROOMS "
GARBAGE DISPOSAL UNIT YES NO ❑
AUTO. DISHWASHER YES NO ❑
AUTO. WASH. MACHINE YES D NO ❑
SITE SUITABLE YES El NO ❑
SIZE OF TANK j �.�- O ` gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual ❑ Public ❑
IMPROVEMENTS PERMIT
CERTIFICATE OF COMPLETION
Y
(8/16/73) *Construction ut comply with 11
LOT AREA
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.
INSTALLED BY
Cep
er applicable State and local regufations
�Z
DAVIE COUNTY HEALTH DEPARTMENT
/C
P. 0. BOX 57 ' L- 7g
MOCKSVILLE, N. C. 27028f�� 1
(704) 634-5985 Q�
Statement for Septic Tank Improvement Permits
and/or Site Evaluations
p < 1J �-C S-;W6-'�-DAT NAPE � �-.; .rZi '" " J �� �E ISSUED
ADDRESS PERMIT N0. /
Explanation of charge
AMOUNT DUE ��, SANITARIAN
4,
/Z�
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.