332 La Quinta Drive (3)DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'INped in Compliance With Article II of G.S. Chapter 130a
a itary Sewage Systems J _ Permit Number
Name l-�o.���'��%,� S�� �CJ� Date ��a/ ��- N2 8204
C�✓.f�F 7cv 6
Location
Subdivision Name 101040-1 t e- Lot No. Sec. or Block No.
Lot Size __ _ House _ Mobile Home _ Business _— Industry
No. Bedrooms aQ_.No. Baths _jc9__ No. in Family __ Public Assembly Other
Garbage Disposal YES ❑ NO lam- Specifications for System:
Auto Dish Washer YES NO ❑ _ ��
Auto Wash Ma thine YES NO ❑ I� v X�X� / ei(>
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 THIS PERMITILAYOUT BEFORE INSTALLING THIS
SYSTEM. - /}
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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.
Final Installation Diagram:
System Installed by
Certificate of Completion datl___ Date g/
'The signing of this certificate shall indicate that the system 'described above has been installed incompliance 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.
DAVIE COUNTY HEALTH DEPARTMENT
,� - IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'N ' Oed in Compliance With Article II of G.S. Chapter 130a
_~ 4�,�a itary`Sewage Systems Permit Number
- Name - � J �. _ ' ` -fi=Date N2 8204
-Location
Subdivision Name 7164,146L llc:� 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 [1 --Specifications for System:
Auto Dish Washer YES NO pJJ -
Auto Wash Ma^hine YES NO ❑ 13-v x? A
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 THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM. / Mf
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I
(/"/ A /' `Ot>UI
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 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 regulationcbut_shall'in NO way be taken as a guarantee that the system will function
satisfactorily for any given period of time. -
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
` '31P ,SAI �1�'PLICATION FOR IMPROVEMENT PERMIT (REPAIR) Q ¢
NAME 6 - f PHONE NUMBER % < 0 �� a�
ADDRESS Q / - SUBDIVISION NAME ODc� ✓Q I ie-
V. Ale, d 4 LOT # W el-Qga/rk�c2 2
DIRECTIONS TO SITE L�'O C7 D u��- %Y%:2 ! 1ti- �I�/'Irk 1 )'k- - �Lf 1 )17n---
Ao m e' d -)'-L r -
DATE SYSTEM INSTALLED Rj�q NAME SYSTEM INSTALLED UNDER
TYPE FACILITY `i P NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY
SPECIFY PROBLEM OCCURRING aCK / (A ���
c
DATE REQUESTED ! -a lINFORMATION TAKEN BY
This is to certify that the information provided is correct to the best of my knowledge, and that I understand 1 am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93