129 W Renee Drive Lot 10..,r. -:..J .. r. ,„..�.., •.Y 1 : ..f..,o. -t`..,,:. ,v,... -ti X,•e -r,_. cr'- t. v i .. •
i
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT PERMIT AND CERTIFICATE OF COMPLETION
' NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage Syste Permit Number
Name a�j 4 Date 6-/3-99 N2 7605
Location CS� \l N � c *4 4Z 0U�
5T '` �. X60 tJ V.l (3-') -zt,11,
Subdivisi n Name��-?s��—�� Lot No. Sec. or Block No. 3 �`
Lot SizeOd �' ���°' House V Mobile Home Business -- Industry
No. Bedrooms — No. Baths — No. in Family Public Assembly Other_
r
Garbage Disposal YES` ❑ NO -❑
Specifications for System': 4 i ax
Auto Dish Washer- YES ❑ -, .NO ❑ A, , 1 4;1
Auto Wash Ma;hine YES ❑�; NO ❑ / 40 t' ' ff . ,,<°
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 pl'ans+o'r the intended use change.
s
t
d.
`tee
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 C
*The signing of this certificate shall indicate that the s)
the standards set forth in the above regulation, but shat;
satisfactorily for any given period of time.
mpletion Date _
stem described.above has been installed in compliance with
in NO way be taken as a guarantee that the system will function
.� DAVIE COUNTY HEALTH DEPARTMENT-�-----
IMPROVEMENTS PERMIT AND.CERTIFICATE OF COMPLETION
- NOTE: tssued in Compliance With Article 11 of G.S�Chapter 130a w
Sanitary Sewage System p Permit Number
Name ���o \� c Date 1 >i N27605
Location :1 \r?J �`=` �� a �) \Zy i\waro
r 1
Subdivisi'nName _�1 s �-`�= �=.�-• Lot No. -J-0 Sec. or Block No. -3
Lot Size 1,60�' w2 a V House 'Mobile Home _ Business _— Industry
No. Bedrooms. No. Baths _ No.
in Family _ Public Assembly Other
Garbage Disposal YES ❑ NO ❑
Specifications for System: I5'6X
Auto Dish Washer , YES ❑ NO ❑
Auto Wash Ma^,hine YES ❑'. NO ❑ i ) U o
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.
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:
r
System Installed by -'
Certificate of mpletion jL Date
'The signing of this certificate shall indicate that the syste bove 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 thesystemwill function
satisfactorily for any given period of time.
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION It
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
L
PHONE NUMBER '19%- 4 9 3 1
ADDRESS 4 R SUBDIVISION NAME
�' tJ c o N LOT #
DIRECTIONS TO SITE 1` y \ CSh si V 1 N h`
DATE SYSTEM INSTALLED `� NAME SYSTEM INSTALLED UNDER
TYPE FACILITY\ NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED �-
TYPE WATER SUPPLY tD Q `r� SPECIFY PROBLEM OCCURRING
DATE REQUESTED -9 4 INFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, and that I understand,) am responsible for all charges Incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1193
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 Ck p�r/� DATE ' QCs• —7 �`" PERMIT
LOCATION (! g,,4 r� l^ �+T r� r37j .y,d .0' *c lr? 611
r S.R. NO.
SUBDIVISION NAME ���, � . LOT NO. SECTION OR BLOCK NO. r
HOUSE MOBILE HOME ❑ BUSINESS ❑
NO. BEDROOMS 3 NO. BATHROOMS %--
GARBAGE DISPOSAL UNIT YES ❑ NO R"
AUTO. DISHWASHER YES ❑ NO ❑
AUTO. WASH. MACHINE YES P'- NO ❑
SITE SUITABLE YES C'' NO ❑
ySIZE OF TANK am-- gal. f
NITRIFICATION FIELD"', sq. ft. ! ��
DEPTH OF STONE IN LINES: l i&l V., yr
WATER SUPPLY: Individual M,"Public ❑
IMPROVEMENTS PERMIT BY
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.
ro .ate. V - e QUWtt'l",g)
o, j,,''e
INSTALLED BY j - ?. /?lnr•'T;n .61
CERTIFICATE OF COMPLETION By Date /a1?- 7ss
(8/16/73) *Construction must mply with all other applicable State and local regulations
LOT AREA
it s
0 5!� / lot e
06v.,�_,a 4AA'