126 W Robin Drive Lot 4t t rr� J �"r { T'{.iF-t,i'i,7 .•:..+;f -. t ,�_;-.;-�,iy.'.,.;...
DAVIE COUNTY HEALTH DEPARTMENT -•
t IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION!
*NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Systems Permit Number
Name _
Location
N27408
Subdivision NamLot No. Sec. or Block No. 2—
Lot
Lot Size __ House Mobile Home _ Business _— Industry
No. Bedrooms —.No; Baths No. in Family _ Public Assembly Other
Garbage Disposal YES ❑ NO (gam Specifications for System:
Auto Dish Washer .YES Q' NO ❑
Auto Wash Main
-h YEAS ( NO ❑
Type Water Supply L,3:
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permit is subjept to revocation if site'plans or the intended use change.
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 _
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.
�-44
' *` 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 ' 1 LI N2 '7 4 0 p
tµZ...(, � " 4) I O
Location
.=��
Subdivision Name_- Lot No. Sec. or Block No. 2—
Lot Size House t� Mobile Home Business Industry
No. Bedrooms > No. Baths No. in Family �. Public Assembly Other
Garbage Disposal YES ❑ NO a-" Specifications for System:
Auto Dish Washer YES (y NO ❑ J _ O f i
Auto Wash Ma thine YES [>� NO ❑ / J
Type Water Supply
v —
*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.
t
nit 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
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 timer ---
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) p
NAME PHONE NUMBER
ADDRESS SUBDIVISION �,�- �� , D / SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE L% r 671W �' � , .L7�• �i �
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER /64/h`?9;::Z �rz _it
TYPE FACILITY NUMBER BEDROOMS 3 NUMBER PEOPLE
/SERVED �-
TYPE WATER SUPPL`Y_&z=1
J
SPECIFY PROBLEM OCCURRING_
I n n
V )) //(()�
/%iil49
DATE REQUESTED �-9��INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, arlf that I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93
DAVIE COUNTY HEALTH DEPARTMENT
(Septic Tank) Improvements Permit and Certificate of Completion
'(Ground Absorption Sewage Disposal System - G.S. Chapter 130 -Article 13C)
LAMER OR CONTRACTOR 1•, DATE -'- _;�+?-'"(4; PERMIT
.. ti.0
LOCATION . ° 528
S.R. NO.
SUBDIVISION NAME Uj 6 of 1e C,, LOT N0. V SECTION OR BLOCK NO. �
HOUSE 1 MOBILE HOME BUSINESS ❑
NO. BEDROOMS :
GARBAGE DISPOSAL UNIT
AUTO. DISHWASHER
AUTO. WASH. MACHINE
SITE SUITABLE
SIZE OF TANK
NO. BATHROOMS
YES
❑
NO
❑
YES
❑
NO
❑
YES
❑
NO
❑
YES
❑
NO
❑
gal.
NITRIFICATION FIELD sq. ft.
DEPTH OF STONE IN LINES:
WATER SUPPLY: Individual Public ❑
IMPROVEMENTS PERMIT BY
CERTIFICATE OF COMPLETION
By—
(8/16/73) *Construction must c
LOT AREA
House Trailer
Two Bedroom House
Three Bedroom House
Four Bedroom House
INSTALLED BY
800 Gal. 400 Sq. Ft.
8 Or„{,.a.],,,_ 600 S q. Ft.
00 ^Gal S,q,::�
1000 Gal. 1200 Sq. Ft.
1 S,i /-"I- <%.1, &) r r�/
Date?--/ P—9,J
with all other applicable State and local regulations
jerk -re-5: Resu I is
FRO
In
1/43