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3164 Hwy 601Sr r. � r - DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance -With Article II of G.S. Chapter 130a Sanitary Sewage Syste'mms�j Permit Number Name �J>✓ %rG:��� Date _f1�19� N2 8074 Locationr2*` Ya i'c'y%G��r,• �/ Subdivision Name Lot No. Sec. or Block No. Lot Size��_-- House — Mobile Home Business —_ Industry No. Bedrooms .No, Baths — — — — No. in Family OZ,/4,��1Public Assembly ' O044-,- Garbage Disposal YES ❑ NO (y Specifications for System: Auto Dish Washer YES ❑ NO 2- Auto Wash Ma^hine YES ❑ NO Type Water Supply f y 1Ae ; :% �'/ r 'This permit Void if sewage systerr�described below isnot installed within 5 yLsarfxo 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 PERMIT LAYOUT EFORE INSTALLING THIS SYSTEM. G' J I 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 —&T^ 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. r Y v. DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLI�710N *NOTE: Issued in Compliance -With Article 11 of G.S. Chapter 130a Sanitary Sewage Systems P/ r - x,/q, / Permit Number " Name ��''// S-� _ r �%/ f�isrl./r Date _� la` f N2 8074 ' Location Subdivision Name 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 ❑ NO g-- Specifications for System: Auto Dish Washer YES ❑ NO [� Auto Wash Ma -hive YES ❑ NO [�' `J ✓� r -Type Water Supply'— 14i—__ — 'This permit Void if sewagesystem'described below is not installed within 5 y ars 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 PERMIT LAYOUT BEFORE INSTALLING THIS SYSTEM. � - C -•C, I Improvements permit by "/L '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. J �r AVIE COUNTY ENVIRONMENTAL HEALTH SECTION �9,�PPygff�OP�-FOR IMPROVEMENT PERMIT (REPAIR) PHONE NUMBER UBDIVISION NAME LOT # DIRECTIONS TO SITE DATE SYSTEM INSTALLED WO'l NAME SYSTEM -INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED < TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING r ' DATE REQUESTEDINFORMATION TAKEN BY-----'`Y�C� This is to certify that the Information provided Is correct to the best of my knowledge, that I understand I am re onsible for all charges incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED'AGENT_ �`�Lo Rev. 1193 Parcel #: M600000017 Davie County, NC - Basic Estate Search Basic Search Real Estate Search Tax Bill Search Sales Search 0 Miew Property Record for this Parcel View Mao for this Parcel View Tax Bill Information Parcel#: M600000017 Account #: 82515527 Owner Information uildin : Tax Codes BXF• ERUSALEM BAPTIST CHURCH INC Land: ADVLTAX - COUNTY T [FIREADVLTAX Market: 203 US HIGHWAY 601 SOUTH ssessed: - FIRE TAX Deferred MOCKSVILLE NC 27028 Property Information Township [Land (Units/Type): 5.210 AC JERUSALEM ddress: 3203 S US HWY 601 Deed Information Local Zoning Date: 04/1977 Book: 00101 Page: 0461 Plat Book: 0004 Page: 049 Le al Description PIN 5.212 AC BOXWOOD ACRES 5755056269 PropertV Values uildin : 1,61973 BXF• 19,49 Land: 55,84 Market: 1 695 06 ssessed: 1,695,06 Deferred Sales Information No Sales Data found. View Property Record for this Parcel View Mag for this Parcel View Tax Bill Information « Return to Basic Search Page 1 of 1 oP� � nO U 10 Davie County Web Site All information on this site is prepared for the inventory of real property found within Davie County. All data is compiled from recorded deeds, plats, and other public records and data. Users of this data are hereby notified that the aforementioned public information sources should be consulted for verification of the information. All Information contained herein was created for the Davie County's Internal use. Davie County, its employees and agents make no warranty as to the correctness or accuracy of the Information set forth on this site whether express or Implied, in fact or in law, including without limitation the implied warranties of merchantability and fitness for a particular use. If you have any questions about the data displayed on this website please contact the Davie County Tax Office at (336) 753-6120. 1.5.9 http://maps.daviecountync.gov/itsnetfView.aspx?prid=1469123 8/2/2016 DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 (336)751-8760 Account #: 990001668 Billed To: Jerusalem Baptist Church Reference Name: Proposed Facility: Church ATC Number: 2779 Tax PIN/EH #: 5755-05-6269 Subdivision Info: Location/Address: 3203 601 S.-27028 Property Size: 5.2 acres AUTHORIZATION FOR WASTEWATER SYSTEM CONSTRUCTION **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any building permit(s). This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for building permit(s) (in compliance with Article 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Tr tment and Disposal Systems). THIS AUTHORIZATION FOR WASTEWA ON IS ALID FOR A PERIOD O FIVE YEARS. Environmental Health Specialist's Signa Date: %O CERTIFICATE OF COMPLETION **NOTE** The issuance of this Certificate of Completion shall indicate the system described on Improvement/Operation Permit 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. , U Septic System Installed By:� 1c� Environmental Health Specialists Signature: ate: i DCHD 05/99 (Revised) DAVIE COUNTY HEALTH DEPARTMENT a� ` Environmental Health Section P. O. Boa 848/210 Hospital Street Mocksville, NC 27028 , (336)751-8760 IMPROVEMENT/OPERATION PERMIT Account #: 990001668 Tax PIN/EH #: 5755-05-6269 Billed To: Jerusalem Baptist Church Subdivision Info: Reference Name: Location/Address: 3203 601 S.-27028 Proposed Facility: Church Property Size: 5.2 acres ATC Number: 2779 **NOTE** This Improvement/Operation Permit DOES NOT authorize the construction 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 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems). THIS PERMIT IS SUBJECT TO REVOCATION IF SITE PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING SYSTEM. Residential Specification: Building Type #People #Bedrooms #Baths Dishwasher: ❑ Garbage Disposal: ❑ Washing Machine: ❑ Basement w/Plumbing: ❑ Basement/No Plumbing: ❑ Commercial Specification: Facility Type Co", #People #People/Shift #Seats Industrial Waste: ❑ �i, x4o WAT129L OSF. (PI GO> Lot Size 12� Aj Type Water Supply �-CJ NWDesign Wastewater Flow (GPD) -"� Site: New ❑ Repair System Specifications: Tank Size I CWGAL. Pump Tank GAL. Trench Width W Rock Depth 17-" Linear Ft---SCn, Other: T, (>--N �S �sr��t_ L, P3ZR.s Required Site Modifications/Conditions: �� �t-�- n1J �r�Tp�P�, S� OAF 3Jti..i� •S� (,ISS 1F G&se, {,- IMPROVEMENT/OPERATION PERMIT LAYOUT - APPROVED ER(S) IF 6 " BELOW FINISHED GRADE. ****NOTICE: Contact a representative of tt a Davie County Health Departm t for final inspection of this system between 8:30 a.m. to 9:30 a.m. or 1:00 p.m. to 1:30 p.m. on tl a day of installation. Telephon # is (336)751-8760.**** %S x3to ��2 � �-w,�t ►S GZ9�" Environmental Health Specialist's DCHD 05/99 (Revised) E -'� Date: APPLICATION FOR SITE [VALUATION/15113ROVENIENT PER&HY & ATC D Davie County Health Department Eni ronmental Health Section 9 P.O. Box 848/210 Hospital Street Mocksville, NC 27028 (336) 751-8760 ENVI UAVIEEcouNnr�LTH 7. Type of water supply: ®'County/City ❑ Well 9. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? �❑ Community . Q'Yes ❑ Nc ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW.. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property -Dimensions: 2A64&5 Tax Office PIN: # Property. Address: Road Name / City/Zip t11aC. Its V,LL fy If in a Subdivision provide information, as follows: Name: WRITE DIRECTIONS (from Mocksville) to PROPER'T'Y: �- Section: Block: Lot: Date Property Flagged: W 1 This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS: Revised DCHD (07/99) f F: Account No. Invoice. No. Ly 0/ ***IMPORTANT*** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVIDED. Refer to the INFORMATION BULLETIN for instructions. 1 �Q✓riSG✓/PIrJ / aff Pcyjq{/ 1. Name to be Billed ,C>c,, i Contact Person (9Yyt7� Mailing Address IV l hW z Home Phone a �� TS �—c7,1_'2y yy{{��%%O City/State/ZIP ////�G961/r11l //`' C p 02 Business Phone 90" e%7/ r v 7 /4 / 2. Name on Permit/ATC if Different than Above Mailing Address,, City/State/Zip Application For: ,el Site Evaluation I(Site _,9 Improvement Permit/ATC ❑ Both 4. system to Service: ❑ House ❑ Mobile Home ❑ Business ❑ Industry Other C 5. if Residence: # People # Bedrooms # Bathrooms U Dishwasher U Garbage Disposal O Washing Machine U Basement/Plumbing U Basement/ o Plumbing Z# 6. If Business try/Other: Specify type People r 'us"5 E1w,^S �y{y # Commodes # Showers # Urinals 4 # Water Coolers 2 IF FOODSERVICE: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: ®'County/City ❑ Well 9. Do you anticipate additions or expansions of the facility this system is intended to serve? If yes, what type? �❑ Community . Q'Yes ❑ Nc ***IMPORTANT*** CLIENTS MUST COMPLETE THE REQUIRED PROPERTY INFORMATION REQUESTED BELOW.. Either a PLAT or SITE PLAN MUST BE SUBMITTED by the client with THIS APPLICATION. Property -Dimensions: 2A64&5 Tax Office PIN: # Property. Address: Road Name / City/Zip t11aC. Its V,LL fy If in a Subdivision provide information, as follows: Name: WRITE DIRECTIONS (from Mocksville) to PROPER'T'Y: �- Section: Block: Lot: Date Property Flagged: W 1 This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by to conduct all testing procedures as necessary to determine the site suitability. DATE SIGNATURE THIS AREA MAY BE USED FOR DRAWING YOUR SITE PLAN (Include all of the following: Existing and proposed property lines and dimensions, structures, setbacks, and septic locations). Site Revisit Charge Date(s): Client Notification Date: EHS: Revised DCHD (07/99) f F: Account No. Invoice. No. Ly 0/ m LLI Nil, W< 0 1-- 0 U 0 111 N ;7 III, L —1 UI LJ i W (0 0)\ a) - m 57< U- --------------- 41 pe) ON in '\1 �71 LO' LLI 04 co cr) LLJ 0 Y, I c1q \4, ----------- 0) r7-' 01 0 0 N \ >- < < ■ Z Lu ry 00 An 00\ Xz CD ♦ IL 4, \\, N, 0- 0 0) 00 0\,O) - 00 k\ ^w lilt I j 00 "\\\\\\�\ \\\\\ ,� \\\\�� II `II \\\� \\\\� \ \\\ �\ \ \ \ \ \ LLJ co CL, LLJ M lilt LL t\ -T LL 1Q, L LJ U U) X\ O\ LLJ, LLJ,\\\ 14 �3: _j 0 in 0-1 \ \ C, ry, \D\LLL-J: —J a) 00 VA) moli L CNI V� LL)< Lo 1 110' a- 10- , 1112 1 L, I I Cy F- F- < Ld AA T -0 0— cy 40 -�j —1V lKn I 00 -gyp a \03 0 IQ 41 00 cu, All, 41# 41V 4$1 aq 10 oo coi oo I co oot 10 0) oo oo Y-: 10 10 10 'o CD rN iy- % 0 10 3 • DAVIE COUNTY HEALTH DEPARTMENT • Environmental Health Section 4 Soil/Site Evaluation APPLICANT INFORMATION PROPERTY INFORMATION Account #: 990001668 TaxPIN/EH #: 5755-05-6269 Billed To-. Jerusalem Baptist Church Subdivision Info: Reference Name: Location/Address: 3203 601 S.-27028161 , I Proposed Facility: Church Property Size: 5.2 acres Date Evaluated: `"� Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit Cut SITE CLASSIFICATION: S EVALUATION BY: LONG-TERM ACCEPTANCE RATE: C). "t OTHER(S) PRESENT: REMARKS: & LEGEND Landscape Position R - Ridge S - Shoulder L - Linear slope FS - Foot slope N Nose slope CC -Concave slope CV - Convex slope T = Terrace FP - Flood plain H.- Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI Silt SICL Silty clay loam SIL - Silty loam CL Clay loam SCL - Sandy clay loam SC - Sandy clay SIC Silty clay C - Clay CONSISTENCE Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) 1 LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) I DEPTH Consistence Mineralogy HORIZON II DEPTH Consistence Mineralogy HORIZON III DEPTH groupHORIZON Texture Consistencer�MEff 1"AELOWIM MA"M ®� Mineralogy �= .Ib ��■o��oHORIZON IV DEPTH POINIM-PIMMINI Structure SOIL WETNESSSAPROLITE SITE CLASSIFICATION: S EVALUATION BY: LONG-TERM ACCEPTANCE RATE: C). "t OTHER(S) PRESENT: REMARKS: & LEGEND Landscape Position R - Ridge S - Shoulder L - Linear slope FS - Foot slope N Nose slope CC -Concave slope CV - Convex slope T = Terrace FP - Flood plain H.- Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI Silt SICL Silty clay loam SIL - Silty loam CL Clay loam SCL - Sandy clay loam SC - Sandy clay SIC Silty clay C - Clay CONSISTENCE Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) 1 LTAR - Long-term acceptance rate - gal/day/ft2 DCHD 05/99 (Revised) NEWS ■■■1\ ■■■ll ■■■■■ ■■■■■ ■ENE■ ■■N■■■■E■■■■EME■ ■■■■■EMM■■E■■EE■ ■MENN■MM■■■■Mss■ ■OMM■M■EN■E■■■E■ ■EME■MEN■■■■ENE■ ■■■■■■■■■NNO■■N■ ■■■■NEN■■■■■■■■■ ■NEEM■■N■■■■N■■■ ■■■■■■■■NE■■■■E■ ■■■■■■■■■E■■■■N■ ■■■■■■■Ne■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ w■■■■■■irr■ ■e■■■■■■n■■ ■■■EMME■"Em ■■■■■■ENVEM ■■■■■■■■R■■ ■■■■■■■NNe■ ■MN■■■■■■s■ ■■■■N■■■■il■ ■O■MEME■■HE ■MEMEME■■11■ ■■■■E■■■■RE ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■e■■■■■■■■■■■■■■■■■■■■Nee■��r�E■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■Nee■■■!%■G:�:l■■■■■■ ■■■■■■■■■■■eeeeeeeeeeeee■■■■■■r►NE.a�iNe■ ■■■■■■■■■■■■■■■■■■■■■■■■Nee■eeY�'�i■:%■■■■ ■■■■■■■■■■a■■■Nees■■■■■e■■■■■■■■►�Ns■■■■■ ■■■■ee■■■■■■■■■■■■■■■■■■■e■■■■■■■■►�■Nee■ ■■■■■■■■■■■■■■Nee■■■■■■■■eee■■■■e■e►�■■■■ ■■■■■■Ire■ee■e■■r■■■■■ee ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■eee■■■■■■■■■■■eee■■Nee■■■■ ■■■■■■■Nee■■■■ecce■■■■■■■■■■■■a■Neese■■■■e�Eeee■■eee■e■■■i■■■■■Nee■ ■■■■■Meeesee■ecce■■■■■ee■■■ee■■■■■■■eeeiel�:■■■e■■ee■■■■■R■■e■■■Nee■ ■eee■■■■■■■■■■M■E■■■■■■■■■■■ee■■■■M■■■■■c;�■■■■■■■■■EEeee■■see■■■■■ ■■■■e■■e■■■■e■■■■■■■■■■■■■■�■e■ee■■■i■■■■■eeee■ee■e■■■ee■eee■e■■■ ■■■E■N■e■es■■er�■■e■■■■■■■■■ ■eeeee■i■■■■■■■■■■■■■■Nee■■■■■■■■■■■■ ■■■■■■■■■■■■e►■■■■■■■■■■■■■■■■■■■■■■r■■■■■■ee■e■■■■■■■■�■e�Ma■■■■eee■ ■■■■■eee■■ae■i■ee■■■i����i a���M■■■■e■■ei■■e■■■M■■■Nee■■■■■�.���■�■■■■■■■■ ■■■■■■■■■e■■■i■ee■:■�c.�■���■■■■■ee■ei■■■eee■■■■■■■■■■■E■a■e■e■■■■■■■ ■■■■■sEM■■■■■i■■e■■s■■eae■�e•���1■■Nei■■■eee■■■■■■■■■■s■■■■■e■■■■■■■■ ■■■■■■Nees■■■u■■eee■■■�r���■■■Liu■■M■ue■ee■e■■■■■■■■■■e■■■■eeee■■■■e ■■■■■■■■E■■■■u■■■■s■e■ee■■el�l■�_•■■��se■■Nee■■■■■■■■■■ee■■Mo■■■■■■■ ■■■■■■■■ee■e■i�ee■■■■■■■Nee■■■■■■■�i■e■■■e■■■■■■■■■■M■e■■■■eN■■■■■ ■■e■■■■■■■■■epee■■■■■■■■ecce■■■■■■■■■■■■■■■e■■■■■■■■■eE■■■■Nee■■■■ ■■■■e■EE■■■ee■E■■■M■e■■■e■ee■■■■■■■■eEM■■■Nee■■■■■■■eee■■■■■Eea■■■ ■■■■■■■e■E■■t_•���������■■■��.��::::■■■■■■Nee■■■■■■■■ecce■■■■e■■■■ ■■■■■see■■■■■■i■�■■■e■iiiiiiiiii■■e■eee■■■ee■■ee■■■■e■■■■e■■■ecce■ ■■■■■MME■■■■■e■■■■■■■■■■■■■■■Mee■eee■■■■s■■■ee■ee■■■■■■■■■■■■■■■■■ ■■■■ees■■■■■■■e■■■■■e■e■■e■�■e■■■■■■■■■■NeeNee■e■■■Nee■■Nee■■■■■■ ■■E■■ee■■■■e■■e■■■e■eeeeee■ ■■e■e■■■e■■e■■■■eee■■■■■■e■■■■■■■■■■■ ■■■■ ■■■■ NONE OMEN MEMO MEMO DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION ` *NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a Sanitary Sewage Sys t ms l Permit Number Name/iisQ� !/�� /��i� ��jf�'i _ -�'� at'e/N2 6139 Locati Subdivision Name Lot No. Sec. or Block No. Lot Size House 1 / Mobile Home _ Business Speculation. No. Bedrooms No. Baths No. in Family - Garbage Disposal YES ❑ NO ❑-'� Specifications for System: Auto Dish Washer YES NO ❑�- Auto Wash Machine YES NO F-1 _ 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. 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. or 1:0071:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram: System Installed by me �dO�(-3 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. ��-~- DAVIE COUNTY HEALTH DEPARTMENT �f _ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION * NOTE: Issued -in Compliance With Artidle I I of G.S. Chapter 130a - Sanitary Sewage Syst ms ,,✓ Permit Number Name... A-22,'. y N2 U39 Locatior �j /:/ /� //� eta / y / '`!'✓ :ri , yi!' [ Li ✓ _+<+i° .l Y ( R�/ -"� Subdivision Name No. Sec. or Block No. Lot Size House 1 / Mobile Home — Business Speculation No. Bedrooms ::�7__ No. Baths.,` No. in Family Garbage Disposal YES ❑ NO ©-' Specifications for System: �} Auto Dish Washer YES NO ❑ i ,.tea Auto Wash Machine YES 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. \ Improvements permit by — *Contact a representative of the Davie County Health Depart ent for final inspection of -this system between 8:30- 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final Installation Diagram:' System Installed by ----- .10 /oo�f3 Certificate of Com Ietion P---- *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. i`