256 La Quinta Drive Lot 1251/0
s 1 DAVIE COUNTY HEALTH DEPARTMENT
• IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NOTE: Issued in Compliance With Article II of G.S. Chapter 130a
S nitary Sewage Pystems jj Permit Number
Name 47 &Date -�� ? N0— 8023
Location
A7
Subdivision Name �"�✓a e t� Lot No. Sec. or Block No.
Lot Size -- — House Mobile Home "��_ Business -- Industry
No. Bedrooms --? —.No. Baths -- No. in Family _ Public Assembly Other
Garbage Disposal YES p NO Specifications for System:
Auto Dish Washer YES p NO
Auto Wash Ma':hine YES 6 --'NO
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
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THI °P RMIT(LAYPUT BEFORE INSTALLING THIS
SYSTEM.
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Improvements permit by —1-6 /
•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.
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r*-- DAVIE COUNTY HEALTH DEPARTMENT
;IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
_ 'F4OTE 'lssued in Compliance With Article II of G.S. Chapter 130a
Sanitary Sewage §ystems / / Permit Number
- Name _�C /�� '`�rDate S��_� _ N2 8023
<� ;Location — /%�/✓.�.��.i ��,, ��f � `;'.S �
Subdivision Name 0dockcL Ile t Lot No. Sec. or Block No.
Lot Size -- — House — Mobile Home `�� Business -- Industry
No. Bedrooms —.No. Baths -22-- No. in Family — Public Assembly Other
Garbage Disposal YES ❑ NO ET—�/ Specifications for System:
Auto Dish Washer YES ❑ NO �T
Auto Wash Ma^hine YES ONO ❑ Sd X GD / HCl,/(
Type Water Supply -- e __---___—
•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
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST.SEE THIS`P.ERMIT(LAYOUT BEFORE INSTALLING THIS
SYSTEM. J
Improvements permit b
P Y ;
*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 b 4
g Y Y
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 beleken as a guarantee that the system will function
satisfactorily for any given period of time.
4.
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
PHONE NUMBER Y7U —per Y,2 I
ADDRESS,9,:i=Z 2Q 1��n �lL �� SUBDIVISION NAME
/`-l0'�/�!�✓G' l� LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY / NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY G SPECIFY PROBLEM OCCURRING
DATE REQUESTED INFORMATION TAKEN BY�
This is to certify that the Information provided is correct to the best of my knowledge, an understand I am res r& 'ble for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1193
- DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE: Issued in Compliance With Article I I of G.S. Chapter 130a
S nitary Sewage ystems J / Permit Number
Name -_^ T1��rDate Sla-- N2 8023
Location — — —
c
Subdivision Name 046liy` d le o Lot No. Sec. or Block No.
Lot Size -- — House — Mobile Home `�� Business -- Industry
No. Bedrooms --:? —.No. Baths No. in Family — Public Assembly Other
Garbage Disposal YES p NO �' Specifications for System:
Auto Dish Washer YES p NO
Auto Wash Ma thine YES ENO [] `'
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
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST-SEETHI kt? RMIT`%LAY�UT BEFORE INSTAWNG THIS
SYSTEM.--
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of -
Improvements
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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.