P7581 Howardtown Rd }(Ii--c..-,�-e+N`fi�"H.-'Oc ..r -+.w*"Y'^_Yt s; r,.�s .:•i� • �.. _ , -
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
`Sanitary Sewage Systems _ Perm-it Number
Name Ra � Q��"�� Date J' 2� " C(f"� N2 f 7 5 O 1
Location 1 _Z- V A N c P
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Subdivision Name Lot No. Sec. or Block No.
Lot Size 'Sd#�O = Houses Mobile Homey Business Industry
No. Bedrooms - n —
No: Baths — N`o m',�,�mily Public Assembly Other
Garbage Disposal YES NO F] � � Sli!cey
Spec ifitirorls for Sy
F1sr tem: ,
Auto Dish Washer YES �NO ❑ _ gA
Auto Wash Ma^hine YESNO ❑ �.r b a,,. �: .P ° ,N *� Y:..,,�1 t �
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Type Water Supply,.— blIJ31. F ----* 6.0 V 3 X g '
*This permit Void if sewage system described"below is not installed within 5'years from date of issue.
This permit is subject to (evo_c�tion if site plans or the intended use change. "w
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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.
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Final Installation Diagram: System Installed by �`^�u—
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Certificate of Completion Date
*The signing of this certificate shall indicate that the system describe 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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• ��� - `� = DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
- -Sanitary Sewage Systems Permit Number
Name �. `�;.• z:.« �a - Cis „sh::F.�. Date N- 758
Location -�-
Subdivision:Name �— -- - Lot No. Sec. or Block No.
Lot Size �O House Mobile Home Business Industry
n
No. Bedrooms No. Baths,, •�, — No. in Eemily -{ Public Assembly Other
Garbage Disposal YES ❑ NO ❑ .�o:... Specifications for System:.
Auto Dish Washer YES,0-'_`NO ❑ _ o,
Auto Wash Ma-hive YES N0 ❑ t y - r I
Type Water Supply;_ f L4.�-
*This permit Void if sewage system described'below is not installed within 5 years from date of issue.
This permit is subject toKevoction if site plans or the intended use change.
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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 Cs. w
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Certificate of Completion Date
.The signing of this certificate shall indicate that the system describe 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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Cti►, 0-�dy /?,4"v " DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
Cho cls' 1'- APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME 1C'N'D ,T,�'"101 PHONE NUMB
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ADDRESS 4 //;/G 14le 4 SUBDIVISION NAME
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! G 2'Jo/i v cL 27o06 LOT#
DIRECTIONS TO SITE /.s�- % �• i�.wadyTiuri� ..,�. ?.�.:� k- '
A h44 &a/z .'ra � v�
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER '
TYPE FACILITY 40 NUMBER BEDROOMS NUMBER PEOPLE SERVED Z
TYPE WATER SUPPLY Pr•v m1�- SPECIFY PROBLEM OCCURRINGruhh-mac
DATE REQUESTED S 'Z ' 9 7 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