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161 Granada Drive Lot 58
r "�, - ! •• µ-•• z tTitl;Y'VTr1-'.°-w• y -n' ." t"v -r�.r -^,r- -'&. . v+.a., t,f NN ..� „n:C:: `r✓.L 1.' 'L' '-1-AJ-•� �v-.. `-.r-. _'t _ .,. ,, 4Yr'f91yr�,,,�„y. „pu DAVIE COUNTY HEAETH'.DEPARTMENT Jed L) 1, TMPRO NT,U'L AND OPERATION, PERMITS PROP RTY INFORMATION Perniittee's ; f -Name-" I4% Subdivision Name: "Directions to property: !` %J #i :�ttk� . Section: Lot: r �': HvIPROVEMENT l •t . f r '�s�lt►il�:' �' PERMIT Tax Office PIN:# ` • fir, ,4 , ,!' «. Road Name: - ,..0 r t. ,Zip; r �+ **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An - AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION must be obtained from this Department prior to the construction/installation of"a system or the issuance of a.building permit. (In compliance with Article 11 f G.S. Chapter 130A, Wastewater Systems, Section .1900• Sewage Treatment and Disposal Systems) " ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE -« PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ' EIv�IR� ALTH SPEC I I SSUED - -SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE. .: INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE - (v 4 # BEDROOMS # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE : # PEOPLE/SHIFT / # SEATS" INDUSTRIAL WASTE: Yes or No LOT S! "TYPE WATER SUPPLYDESIGN WASTEWATER FLOW (GPD) /' NEW SITE. • REPAIR SITE SYSTEM, SPECIFICATIONS: TANK SIZE • GAL. PUMP TANK GAL. UMq@WWIDTH ` kOCK DEPTH 1 LINEAR FT. REQUIRED SITE MODIFICATIONS/CONDMONS: d� 1 rpt 1" 1`! • �� ' H 1 y CP r 1 ""' u Y .. **CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY HEALTH DEPARTMENT FOR FINAL IIVSPECTION.OF THIS SYSTEM": �S , BETWEEN 8:30 - 9:30 A.M. OR 1:00.-,1:30 P.M. ON THE DAY OF INSTALLATION. TELEPHONE #„IS (IK 7514760' SYSTEM INSTALLED BY: 7/7" /� L---------- AUTHORIZATION NO70M A OPERATION •PERMIT B ;• s ' _ • DATE: U **THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE DESCRIBED AB S BEEN INSTALLED IN COMPLIANCE WITH ARTICLE 11'OF G.S. CHAPTER 130A, SECTION .1900 " SEWAGE .TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL INNO WAY BE TAKEN AS A GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANYGIVEN ERIOD OF,.TIME: DCHD 05/96 (Revised) v 1 } AU7-HQRIZATION NO DAVIE COUNTY HEALTH DEPARTMENT `'V Environmental Health Section PROPERTY INFORMATION Permittee's�j y ( P.O. Box 848 Name: r.iJtJ t C >) 11 � � _ Mocksville, NC 27028 Subdivision Name: W � Phone # 336-751-8760 Directions to property: Ur1 t i 1� Section: Lot: / ,? AUTHORIZATION FOR WASTEWATER Tax Office PIN:# _ SYSTEM CONSTRUCTION 0� Road Name:';,' *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 Article 11 of G.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. �.,. VlRO1IM TAf H€'ALTH SP CIA DAT SUED hLy DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) , / NAME /`���� �/r �' PHONE NUMBER 70©-9�/`f ADDRESS Ll�(S��'�CG�� SUBDIVISION NAME LOT # DIRECTIONS TO SITE DATE SYSTEM INSTALLED �'Qd S NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED _ 24 TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING U r� DATE REQUESTEINFORMATION 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 -/7/// / %/ A "i—SJ c97/07