P7275 Howell Rd 'Y��:'"- rowy yval�''^'4'�yf .-w ci- ^5`?-.r.w..•�. _ .tea- ��--.- »'Lrr"s"'r'N rati*s�:.a.c�'�D�:F"Tri•--�.Q„_�c'n:"""-[^`.-"? a.
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article II of G.S. ��pt f30a
SWita SSe}^�a 'Syste Permit Number
Name Klit/Q �c� 7i��0}✓a1� Date �'�.�.9 NO 727.5
Location ✓/� "",v .�17 .� /Y�=///,/ —
Subdivision Name Lot No. Sec. or Block No.
Lot Size �� House Mobile Home_T Business Speculation
No. Bedrooms No. Baths No. in Family —
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma:hive YES [:] NO ❑ '�`�'['�� so-'�
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.
E
gAed
r
✓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 1:00-1:30 P.M. on day of completion. Telephone Number 704-634-5985.
01
Final Installation Diagram: System Installed by
N
l
Certificate of Completion Z4 Date `
'The signing of this'certificate,shall indicate that the system described above has been installed incompliance with
the standards set forth iri 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.
.a` ��.rt" :;ai! i Y�+n �(`�, t � . a�sar 7` ,-' y+�. ,,., '�Ln[.��"f�s..,""- •.
DAVIE COUNTY HEALTH DEPARTMENT
__ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION. _
-
.0'..-v, -.*NOTE:Issued.in-Cocnptffa ce With Article II of G.S.C �ypt 30a`
t y�S,�w I Syst Permit tl� r .
Name �I tt7' �� Date NO ((
Location+� y
Subdivision Name Lot No. Sec. or Block No.
Lot Size T— se.,HouMobllei-Home . Business _— Speculation
No.,Bedrooms _.No. B'Mhs Nor in Family
Garbage Disposal YES p NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO -❑
Auto Wash Ma:hive 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:
. r
• i
Improvements permit by —
»r .
*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 day of completion. Telephone Number 704-634-5985.
AbFinal Installation Diagram: System Installed by —
'a
1
k `s
i
%/ /� - -
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.
A
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME X1 `i t / J laIla,e P_ PHONE NUMBER
ADDRESS DA-' c2 7/- ,� SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE Ao/Wel
DATE SYSTEM INSTALLED 3 NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY �i//� SPECIFY PROBLEM OCCURRING
DATE REQUESTED INFORMATION 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