189 La Quinta Drive Lot 6AUTHOkl^TION NO: 16 8 3A DAVIE COUNTY HEALTH DEPARTMENT 10:��
Environmental Health Section PROPERTY INFORMATION
' •--Pe"rmrttee's P.O. Box 848
Name: Mocksville, NC 27028 Subdivision Name:
n Phone # 336-751-8760
Directions to property: j�MI)CA,i,,rl/i i' � ►` Section: Lot
AUTHORIZATION FOR
L 1\' tf-�Vtsj,)& .%Q. (Qlyl. .tA. Ul,jA,ir WASTEWATER
SYSTEM CONSTRUCTION Tax Office PIN:# - -
tarJ t_t F i L'1 Road Name: :..^ ia,V�rJ 1n ZiP:21co(,
*NOTE**. This Authorization for Wastewater System Constriction 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•forBuilding Permits.
(In compliance with Article 11 `f G.S. Chapter, 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
ti
***NOTICE*** THIS AUTHORIZATION FOR WASTEWATF.RCONSTRUCTION
' IS VALID FOR A PERIOD OF
' /
tNVllt )K' ALTH PECIALIST DA SUED
1.7
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENT AND OPERATION PERMITS, PROPERTY INFORMATION
ttee's
E
Name: Subdivision Name: Woc,�,VALChY
Directions to property: Section: '�'Lot:
IMPROVEMENT,
PERMIT Tax Office PIN:#- -
L L Z;,'k�'r-
Road Name: Zip,
**NOTE** This Impiovement 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 11,6f G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal, Systems)
***NOTICE*** IIIIS PERMIT IS SUBJECT,TO REVOCATION IF SITE
PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
4
SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE
ENVIROf4Mb4TAJ:FffALTH SPECIALIST 4SRUED
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE M N #BEDROOMS :r2- #BATHS 2- # OCCUPANTS GARBAGE DISPOSAL: Yes orTo
COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLEISHIFT #SEATS INDUSTRIAL WASTE: Yes or No
LOT SIZE TYPE WATER SUPPLY-.�N-Oy DESIGN WASTEWATER FLOW (GP-,�ok NEW SITE REPAIR SITE,
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH ROCK DEPTH LINEAR Fr. (r;o.'
OTHER lig --ITC
REQUIRED SITE MODIFICATIONS/CONDITIONS: t) T:),
"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 # 1%W.),634�7N,.
OPERATION . PERMIT. SYSTEM INSTALLED BY. Am C--;e-tmet s
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AUTHORIZATION NO. 10 5-APERATION PERMIT 11 DATE:
L
TETH STEM DESC
D
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TH STEM DESCRI D A HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE I I OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
I
DAVIE COUNTY, HEALTH DEPARTMENT
T IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
Name: A - (. ! t ; Subdivision Name: JC -0) V L l
Directions to property:`' r '` i `•" '. 4 ' Section: •Lot:
UVIPROVEMENT
PERMIT
Tax Office PIN:#
Road Name:
**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
r construction/installation of a system or the issuance of a building permit.
(In compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
.t Of
***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
/ '= : .a PLANS OR`THE INTENDED USE CHANGE. YOUR WASTEWATER
ENVIRONMENTAL REALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST. SEE THIS PERMIT BEFORE
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE('1 N #BEDROOMS a # BATHS z �" #0 ccUPANTSGARBAGE DISPOSAL: Yes oc(1o?
COMMERCIAL SPECIFICATION: FACILITY TYPE #�EOPLE # PEOPL6SHIFT # SEATS INDUSTRIAL WASTE: Yes or No.
LOT SIZE TYPE WATER SUPPLY�DESIGN WASTE ATER FLOW (GPD) 7 NEW SITE REPAIR SITE ,
SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. T-RBNCIiWiDTH ROCK DEVM'�� .. LINEAR FT 6,0
OTHERi !� ST%.1 f+tfTlun� ROY
REQUIRED SITE L+:-7 7SLrZ E A G� sv, i AT..R A do R -S 10 � � . 14E E.
"CONTACT A REPRESENTATIVEOFITHE 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 # IS(M4Y63"760.
(336)751—t37h0 t...
OPERATION PERMIT
SYSTEM INSTALLED BY:
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C.", . :,\
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AUTHORIZATION NO. 1(0 APERATION PERMIT B i DATE: `/ /1
"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT STEM DESCRIBED A E HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11 OF G.S. CHAPTER 130A, SECTION .1900 "SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)