145 Alvis Trail r''w:.��,s—rvM,r,;�-�c.w7.+r...wwYN'�'�u:M"_ �y _,q-,.3Sr` 'r F'i "'r x7'-vc b id""' yt" ':. ":�"` S--r�^-y'e'a•,i
~ 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 ,J Date No 7 0.4 6
LocationWK
s
Subdivision Name Lot No. Sec. or Block No.
Lot Size ':�'--"s�'- House Mobile Home Business _— Speculation
No. Bedrooms �- No: Baths 'No. in Family _
Garbage Disposal YES ❑ ,NO B/ Specifications for System:
Auto Dish Washer YES p' NO r-1
Auto Wash Ma^hine YES NO ❑ ° � 5°' 3 .�( 12 r`�
Type Water Supply __—
M *This permit Void if sewage system described below isnot installed within 5 years from date of issue. _-
This permit is subject to revocation if site plans or the intended use change.
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Improve a it by
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*Contact a representative of the.Davie County Health Department or final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telepho umber 704-634-5985.
Final Installation Diagram: System Installed by_B
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Certificate of Completion Date 3 - 13
*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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DAVIE COUNTY HEALTH DEPARTMENT
' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
07"
*NOTE:Issued in Compliance With Article 11 of G.S.Chapter 130a
f Sanitary Sewage Systems Permit Number
Name T �"��� Date 3 NO 7 0.4 6
Location V �s 4�f> j o
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _V Business __ Speculation
No. Bedrooms �- No. Baths 1 No. in Family 3 _
Garbage Disposal YES ❑ NO ETI, Specifications for System:
Auto Dish Washer YES [T NO p
u
Auto Wash Ma.hine YES NO ❑ � � 5°' .�(
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.
m. HO
i
.Improve e t pe�it by
*Contact a representative of the Davie County Health Department or final inspection, of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telepho umber 704-634-5985.
Final Installation Diagram: System Installed by_B o b > o p
z
Certificate of Completion Date 3 J 3
'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.
1. :::., 1'` -. i"_. „_. .V,.."e. ti{:...,r, . R .�:..;. :n't311 t..yy,. .i•iti.'.1`.t!' 4- y '.-:s 'Y 1i'�`. .t :- a s 1 ':'t •- 2' Sal
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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NOTE:Issued in Compliance With Article II of G.S.Chapter 130a
- Sanitary Sewage,Systems R Permit Number
Name '_� .�., Date f ,
46
Location - _
_T_
Subdivision Name Lot No. Sec. or Block No.
Lot Size ' House Mobile Home Business -- Speculation
No. Bedrooms ' .,No. Baths — No. in Family —
Garbage Disposal YES E] NO i� Specifications for System:
Auto Dish Washer YES [f NO ❑
Auto Wash Ma-.hive YES NO ❑ , "� 3 k -` �"�-tom
Type Water Supply __—
*This permit Void if sewage system described below is not installed within 5 years from date of issue.
This permitis subject to revocation if site plans or the intended use change.
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(1. Horo"
Ll r `/.
q., V
Improve entsrmit by
I '
'Contact'a representative of the Davie County Health Departmen for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30:P,M. on day of completion. Telen Number 704-634-5985.
Final Installation Diagram: —� System Installed by —� °� ` o p 44•
s
As ShdW N
s
Certificate of Completion Date
'The signing 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.
DAVIE4i.COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
"Note: Issued in Compliance with G:S.'of,North Carolina Chapter-130—Article 136.
Permit Number
Name, f /��a �/ / / Date i
- 3014
Locationi -
,�,���
T Subdivision Name t Lot-.No. Sec. or Block No.
Lot Size �� House r Mobile Home;,'_�� Business Speculation
No. Bedrooms ,yt No. Baths No. in Family I;
Garbage Disposal YES -C] NO
!'!' Specifications .for System:. �
Auto Dish Washer YES NO
Auto Wash Machine YES .u NO p� : f
Type`Water Supply .
`This permit Void if sewage system Xoscribed,',below is not installed within 36 morithsIfrom date of issue.
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.
Final Installation Diagram: System I tall d by
Certificate of Completion Date /s ,
*The signing of this certificate shall indicate that the system described above has been installed''in compliance with i
the standards set forth in the above regulation, but'shall in NO way betaken as a guarantee that the,system will function 1
''satisfactorily for any given period of time.
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME 2 / / PHONE NUMBER
ADDRESS �Le.. ��� SUBDIVISION NAME
/✓
LOT #
DIRECTIONS TO SITE /�� �G ��s l'r�� �!� /-V-
DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY e / ..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.
_ . ,r
SIGNATURE OF OWNER OR AUTHORIZED AGENT -/41 't--
Rev.1/93