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P7687 Country Ln .. 4^•r ""YFw4fi•F .:...sy 'i'�';� 51` y4rv�4..•e',:�--:,v^+.-4r..wii�k`•:.:•v�'.': .i " —,f R..Rr't'^ �sy -rt 4 R;+y .. ,. .... v .. DAVIE COUNTY HEALTH DEPARTMENT QQ9 IMPROVEMENTS PERMIT AND CERTIFICATE OF,COMPLETION j� ki` NOTE:Issued in Compliance With Article II of G.S.Chapter 130a 31 " Sa itary Sewage Syste s Permit Number Name _ �" l'� _ y��� NO S1" Location �I-Al 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 ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ ,� Auto Wash Ma^hine YES ❑ NO ❑ o�Q©,����� 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 fntende see Change. 1 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 S&2 G/ 5101, v -�s- 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. .. 4^•r ""YFw4fi•F .:...sy 'i'�';� 51` y4rv�4..•e',:�--:,v^+.-4r..wii�k`•:.:•v�'.': .i " —,f R..Rr't'^ �sy -rt 4 R;+y .. ,. .... v .. DAVIE COUNTY HEALTH DEPARTMENT QQ9 IMPROVEMENTS PERMIT AND CERTIFICATE OF,COMPLETION j� ki` NOTE:Issued in Compliance With Article II of G.S.Chapter 130a 31 " Sa itary Sewage Syste s Permit Number Name _ �" l'� _ y��� NO S1" Location �I-Al 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 ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ ,� Auto Wash Ma^hine YES ❑ NO ❑ o�Q©,����� 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 fntende see Change. 1 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 S&2 G/ 5101, v -�s- 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. °I o DAVIE COUNTY HEALTH DEPAPTMENT 40� _ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION,, ` JOT- E.Issued in Compliance.With Article 11 of G.S.Chapter 130a - Sa ittary Sewage Syste s Permit Number Name i P �' �'r' _------Baie., �59`� N2 16 8 7 -Location j/ A / �a��.r� a4 Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _____ Business __ Industry No. Bedrooms _.No. Baths an? — No. in Family — Public Assembly Other Garbage Disposal YES ❑ NO ❑ j Specifications for System: Auto Dish Washer YES ❑ NO '❑ ' V V „ Auto Wash Ma thine YES ❑ NO ❑ ' e00 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 'nten }asechange. .✓ .. `, 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 EI- 1 G� r" Certificate of Completion Date 'The signing of this certificate shall indicate thatthe system described. above has been installed in compliance with the standards set forth in the above regulation, but shall in NO waibe,taken as a guarantee that the system will function 'satisfactorily for any given period of time. °I o DAVIE COUNTY HEALTH DEPAPTMENT 40� _ IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION,, ` JOT- E.Issued in Compliance.With Article 11 of G.S.Chapter 130a - Sa ittary Sewage Syste s Permit Number Name i P �' �'r' _------Baie., �59`� N2 16 8 7 -Location j/ A / �a��.r� a4 Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _____ Business __ Industry No. Bedrooms _.No. Baths an? — No. in Family — Public Assembly Other Garbage Disposal YES ❑ NO ❑ j Specifications for System: Auto Dish Washer YES ❑ NO '❑ ' V V „ Auto Wash Ma thine YES ❑ NO ❑ ' e00 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 'nten }asechange. .✓ .. `, 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 EI- 1 G� r" Certificate of Completion Date 'The signing of this certificate shall indicate thatthe system described. above has been installed in compliance with the standards set forth in the above regulation, but shall in NO waibe,taken as a guarantee that the system will function 'satisfactorily for any given period of time. V DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION *. APPLICATION FOR IMPROVEMENT PERMIT(REPAIR) JOY NAME l ,i���s PHONE NUMBER ADDRESS ��� CJ SUBDIVISION NAME LOT# DIRECTIONS TO SITE �� / a4e�yW 24x-el DATE SYST1 EM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY 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 1 unders nd 1 am responsible for all charges Incurred from this application. SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev.1/93