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117 Brookhill Circle Lot 38- - DAVIE COUNTY HEALTH DEPARTMENT�Ts O.00 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a Sanitary Sewage Systems 1 Permit Number 1 _ Name �--,�``a�._r:.,�� -- Date - J 0 8065 Location �� •�,z��;�b�. L�. —\. �} �� ` N ._\. <`t�(JU b v)�,�`_ Subdivision Name ��— �rT Lot No. _' Q Sec. or Block No. 3 Lot Size Hou�2___, Mobile Home ---- Business -- Industry 3 No. Bedrooms —.No. Baths -- No. in Family — Public Assembly Other Garbage Disposal YES 0- NO E)Auto Specifications for System_; Dish Washer YES Auto Wash Ma^hive YES NO ❑ / x 3 t I 21, Type Water Supply --- C ° v----- --- X '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 41 ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THI$,P�R�11T1i G�U �EF E{NSTALLING THIS SYSTEM. , .t4rR- . 1 1I) _ C 01 60 U7 U k v 1= (A o kj P Improvements permit bytL1��-'`", `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 _ Ds" 0 k Q k P k, -Co y FIJ-5 's i`u W Certificate of Completion_1 -- Date U –3 �y 1 '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 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION 'NOTE: Issued in Compliance With_Article II of G.S. Chapter 130a Sanitary Sewage Systems Permit Number Name Date �= 1 t' N2 8065 Location —I—► Z �f t _ — �`�, ._ 77 ��Z3� 7 fCUPI777 Subdivision Name n t Lit No. Sec. or Block No. Lot Size— `= r"— House Mobile Home ---_ Business -- Industry No. Bedrooms —__No. Baths --_`= No. in Family I — Public Assembly Other It Garbage Disposal YES p' NO p Specifications for System: Auto Dish Washer YES [q NO p Auto Wash Ma,:hine YES D- NO ❑ / �� ' J X , J Type Water Supply --- ° .1 --- '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 P1ERMIT�LAYOUT-BEFOP.E,INSTALLING THIS SYSTEM. • r -------- --- 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 t F�5 S i� 6 w V` Certificate of Completion �_ �N.�Q __ 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. i. DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) PHONE NUMBER l 1 z A ADDRESS 1 v-7 vy" SUBDIVISION NAM AN"A , \�•�'• LOT# DIRECTIONS TO SITE / 5 -�' - F:�-o I N - J-'- c DATE SYSTEM INSTALLED b'�►�-o+� NAME SYSTEM INSTALLED UNDER TYPE FACILITY ams NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED 4 TYPE WATER SUPPLY S SPECIFY PROBLEM OCCURRING A � Q a. cttiut,�. DATE REQUESTED L - a2 -'1-5 INFORMATION TAKEN BY QS�fa This is to certify that the information provided is correct to the best of my knowledge, Wd that I underSod I V7responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1/93 DAVIE COUNTY HEALTH DEPARTMENT • - ` I ',(Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption ,,Sewage Disposal System - G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR ez DATE PERMIT LOCATION 1930 S.R. NO. SUBDIVISION NAME li/yoc%L1 LOT NO. "yt� SECTION OR BLOCK NO. r."► HOUSE ❑ MOBILE HOME ❑ BUSINESS ❑ House Trailer 800 Gal. 400 Sq. Ft. NO. BEDROOMS NO. BATHROOMS Two Bedroom House 800 Gal. 600 Sq. Ft. GARBAGE DISPOSAL UNIT YES ❑ NO lam" Three Bedroom House 900 Gal. 900 Sq. Ft. AUTO. DISHWASHER YES . E3'- NO ❑ Four Bedroom House 1000 Gal. 1200 Sq. Ft. AUTO. WASH. MACHINE YES 92 "- NO ❑ R � %� /!l i z l � i l f. '. e- tr r"s` SITE SUITABLE YES Gg--'NO ❑.cam 70P'SIZE OF TANK gal.i�,,,�/' (%X NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES:\ WATER SUPPLY: Individual' ❑ Public IMPROVEMENTS PERMIT BY, Tle7 I INSTALLED BY CERTIFICATE OF COMPLETION By / Date (8/16/73). *Construction must comply with all ovKr applicable State and local regulations LOT AREA �� %,.��.q, A�j,dvf •s'� `J4 .:- � �. ,',Ld� � � r-. a ci'.'t �i j� •'�}} . i� G �il��S DAVIE COUNTY HEALTH DEPARTMENT ! -,(Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption Sewage Disposal S steG.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR `I'� I- ,J16TE 3i-- %,F PERMIT LOCATION��17I rl ��_'�}`; :r ^5 %� - 3' Sf ?!U /r"�7` i.�� /�/.a�%.l�f - �f�: / �a �� y� N9 1853 S. R. NO. SUBDIVISION NAME LOT NO. -45 R' SECTION OR BLOCK NO. 3 HOUSE HOME ❑ BUSINESS NO. BEDROOMS .3 NO. BATHROOMS ,2.. GARBAGE DISPOSAL UNIT YES ❑ NO 0— AUTO. DISHWASHER YES Q'' NO ❑ AUTO. WASH. MACHINE YES ©" NO ❑ SITE SUITABLE YES ❑ NO ❑ SIZE OF TANK _ _ gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: elGU4 WATER SUPPLY: Individual ❑ Public IMPROVEMENTS PERMIT BY House Trailer Two Bedroom House Three Bedroom House Four Bedroom House 5'�5�<.� rags%fd ire 800 Gal. 400 Sq. Ft. 800 Gal. 600 Sq. Ft. 900 Gal. 900 Sq. Ft. 1000 Gal. 1200 Sq. Ft. ,S s`�r+. – � J'•'y ire 4�`'`"��l� S ,�v 1 fc;.. , INSTALLED BY CERTIFICATE OF COMPLETION By Date (8/16/73) *Construction must comply with all other applicable State and local regulations LOT AREA i DAVIE COUNTY HEALTH DEPARTMENT - . . • (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption Sewage Disposal�Svstem G.S.. Chapter 130 -Article 13C) OWNER OR CONTRACTOR (-= % =-- �% DATE " �' ii!' PERMIT LOCATIONt�//,�', _� /.", --f -t 1853 S.R. NO. SUBDIVISION NAME LOT NO. SECTION OR BLOCK NO. 3 HOUSE 2r MOBILE HOME U BUSINESS ❑ NO. BEDROOMS ..+ NO. BATHROOMS GARBAGE DISPOSAL UNIT YES ❑ NO 2-, AUTO. DISHWASHER YES (Hr' NO ❑ AUTO. WASH. MACHINE YES Lam" NO D SITE SUITABLE YES ❑ NO ❑ SIZE OF TANK gal. NITRIFICATION FIELD sq. ft. DEPTH OF STONE IN LINES: WATER SUPPLY: Individual ❑ Public IMPROVEMENTS PERMIT BY j .r✓ House Trailer Two Bedroom House Three Bedroom House Four Bedroom House rye%f iwi .'iit}'/ 63 0-1 INSTALLED BY 800 Gal. 400 Sq. Ft. 800 Gal. 600 Sq. Ft. 900 Gal. 900 Sq. Ft. 1000 Gal. 1200 Sq. Ft. CERTIFICATE OF COMPLETION By Date (8/16/73) *Construction must comply with all other applicable State and local regulations LOT AREA r DAVIE COUNTY HEALTH DEPARTMENT P. 0. BOX 57 MOCKSVILLE, N. C. 27028 (704) 634-5985 Statement for Septic Tank Improvement Permits and/or Site Evaluations NA14E V n"hn / ADDRESS ?,e), 13Z ?0.5' C•Lo„^�", tnd /L ra �' DATE ISSUED S=3/ -7-P PERMIT NO. / FS3 Explanation of charge AMOUNT DUE i.S.dD SANITARIAN PLEASE REMIT THE ABOVE AHOUNT ON RECEIPT OF THIS STATEMENT.