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137 W Renee Drive Lot 11.., b •t•! t��r .. r. t .,�:r yr..6r r. r;. -, :; r�.o r "`__. � .. . . AUTHORIZATION NO: 137 % DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section PROPERTY INFORMATION" Ferrnittee*s P.O. Box 848 Name: i`�hr�e-� t�.�1i f ti Mocksville, NC 27028 Subdivision Name: Directions to property: 1 7-G, 6_ Phone # 336-751-8760 UI /✓ Section: Lot: AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION Tax Office PIN:# - - ,) rr� Road Name: y,1 .: M t Zip:% : I;r-- b **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building -Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for'Building Permits. (In compliance with - icle I Yof O.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRON ErTkE' PECIALI D EISSUED r� T a. - ' -,- r�!l.'•Y.+,..jy(y,M".';"""T' .'4,;.•R'�„'i' w.- ;+zasr. ,.-� - vyT—�'W�Y...- FY•'- .r,`�,n 7'dr-� M.� y %YA _l ,�-1A�� ..,.a E DAVIE WUNTY HEA LTH' DEPARTMENT ('0.' 'Q 4 TNIPROVEMENT AND OPERATION PERMITS ..PROPERTY I©RATION" `"' " ' Name �`ie,• '`t,� r " Subdivision. Name: Directions to property, / 7t,, 06i %'��� Section: 3 Lot: IMPROVEMENT i�,% a' .'J #' &+J#� '' ^i.• PERMIT •T ax OfficePIN:# re �. °" r� ' •' . - -Road- ame:tt.` '„, + 14v, 't ' Zip: ... **NOTE*.* This Improvement Permit DOES authorize the construction or installation of;a septic tank system or.any wastewater system. An ,AiJTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the contra tion/mstallationof a system or the issuance.of a building permit..' (In compliance with Article 1 of�G:S.'Cha ter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE U PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER O r PE&I L l U. E ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. :RE'' SID. E,NTIAL SPECILFIICATION: BUILDING TYPEt;4 605y # BEDROOMS #BATHS '� # OCCUPANTS GARBAGE DISPOS r No ' COMMERCIAL SPECIFICATION FACILITY TYPE # PEOPLE # PEOPLEISHIFr # SEATS INDUSTRIAL WASTE: Yes or No t 'LOT SIZE TYPE WATER sUPPL} II`� DESIGN WASTEWATER FLOW.(GPDOI,� , NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH L ROCK DEPTH t "i LINEAR Ff. f _LWOTHER 1 0,161i�p+eJ>t —. REQUIRED SITE. MONS/CONDITION Li ROP **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 THE DAY OF INSTALLATION. TELEPHONE # ISI%/NH ci 7Si-19768 DCHD 05/96 (Revised) ' • DAVIE COUNTY HEALTH DEPARTINIENT ` ' ' (Septic Tank) Improvements Permit and Certificate of Completion • (Ground Absorption Sewage Dispo al System - G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR CA / Veil C DATE • - PERMIT M LOCATION f �^� y, ,QO I C u / I. /V 0 d• - '�} G N9 610 S.R. NO. SUBDIVISION NAME LOT NO. j SECTION OR BLOCK NO. -3 HOUSE Q' MOBILE HOME [:1BUSINESS F-1NO. BEDROOMS .3 NO. BATHROOMS ir"" GARBAGE DISPOSAL UNIT YES ❑ NO " [B" AUTO. DISHWASHER YES ❑ NO ❑ AUTO. WASH. MACHINE YES 0' NO ❑ SITE SUITABLE YES GV'NO ❑ SIZE OF TANK C67' gal. NITRIFICATION FIELD �j % jsq. ft. DEPTH OF STONE IN LINES: ✓� If�P WATER SUPPLY: Individual ❑ Public ❑ IMPROVEMENTS PERMIT BY f". f House Trailer Two Bedroom House Three Bedroom House Four Bedroom House .-7(-C cNr r 800 Gal. 400 Sq. Ft. 800 Gal. 600 Sq. Ft. 900 Gal. 900 Sq. Ft. 1000 Gal. 1200 Sq. Ft. -/o,P 1; -r P'P Y INSTALLED BY L 0\+1y'k;h CERTIFICATE OF COMPLETION B, J M Date J ,2 (8/16/73) *Construction must c ply with all other applicable State and local regulations LOT AREA Q ;-7 C1 ?00 16-300 Z� -7 00 ?2$ 00 Ck'r, see \0 fV% r- ' Rea rd 0 IV a� `D jult'vo DP I rob DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) L.J PHONE NUMBER '�3 L -198 V 9 ADDRESS l a -Z SUBDIVISION NAME J ° Gf I { �- rA-.A.- J w �. t. sI Cr 2-7 J o 11 LOT # I DIRECTIONS TO SITE Y• }-0 8 u N / . L-2 C43 Lc -F --t- (34--1/41-Le DATE SYSTEM INSTALLED 4' NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY �,O t-C.n-'1-L/ SPECIFY PROBLEM OCCURRING�P-.r,4- W- 4 - DATE 4-- DATE REQUESTED `f—/O- a i INFORMATION TAKEN BY This is to certify that the information provided is correct to the best of my knowledge, and that I understand I am responsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1/93 9-1V AA,st, 0 1r--" ^A.x 07-01 1M DAVIE COUNTY HEALTH DEPARTMENT (Septic Tank) Improvements Permit and Certificate of Completion (Ground Absorption Sewage ,f/�Dispo al System - G.S. Chapter 130 -Article 13C) OWNER OR CONTRACTOR R!.k ;/ Vf..'O C DATE PERMIT LOCATION ''o 1, 610 S.R. NO. SUBDIVISION NAME LOT NO. ��_ SECTION OR BLOCK NO. -3 HOUSE [J" MOBILE HOME G BUSINESS ❑ NO. BEDROOMS -3 NO. BATHROOMS -Oa-- GARBAGE Oa-"GARBAGE DISPOSAL UNIT YES ❑ NO 03" AUTO. DISHWASHER YES ❑ NO ❑ AUTO. WASH. MACHINE YES LTJ` NO ❑ SITE SUITABLEYES ge""NO [3SIZE OF TANK co gal. NITRIFICATION FIELD 03 sq1. ft. DEPTH OF STONE IN LINES: r`v . AT I ve/ c WATER SUPPLY: Individual �� El, 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. ItA r v 7rt� f� o S j7,01P t ♦ I INSTALLED BY CERTIFICATE OF COMPLETION By %.,).eW\o a Date 1a.S -)-7 (8/16/73) *Construction must c ply with all other applicable State and local regulations LOT AREA Q see_ ,o� ,— �z Re`a_d D7 tm I