Loading...
1531 County Line Rd DAVIE COUNTY HEALTH DEPARTMENT L4 IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article II of G.S.Chapter 130a Sanitary Sewage Systems Permit Number Name— Ny s Date cl N2 5990 Locationy o X 3 G Subdivision Name J Lot NoL.S' Sec. or Block No Lot Size House V Mobile Home — Business Speculation No. Bedrooms 3 No. Baths — — No. in Family14 Garbage Disposal YES [] NO Specifications fog,System: Auto Dish Washer i YES.�)'NO ❑ 'Auto Wash Machine YES``V NO ❑F' :.k ,� ';: . a U�, X �''3• t ,7C` , Type Water Supply *This permit Void if se.Wage!Ayst6m described below is not installed within 5 years from date of issue. This-permit is subject to revocation if site planIor the intended use change. � D i a ri Improveme is 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: r System Installed by �+a�� Certificate of Completion Date 6 - 6- 70 v r w "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 , DAVIE COUNTY HEALTH DEPARTMENT �- , �� IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *P40TE:Issued in Compliance With Article 11 of G.S,Chapter 130a -NIumber . Sanitary Sewage Systems Perm_ it mber '",Name s N �� • v S� Date N2 5990 Location VA I o A � la3 � As m o ,�4 \! Subdivision Name Lot No. Sec r ` \ or Block No, Lot Size �1 � House Mobile Home _ Business Speculation No. Bedrooms 3 No. Baths No. in Family Garbage Disposal YES ❑ NO M/ ``Specifications for System: j Auto Dish Washer YES L), NO ❑ s Auto Wash Machine YES [tom NO ❑' vU' )( '" .3 1 x ` �►i - Type.,Water Supply C L-1ti'�C v --- {Y r *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. D (/• 8 Improveme is permit bye- �-�� \�\ *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 Installed byIT4-4. C•-� � --�^�^� V1 Certificate of Completion Date o ?b (\ *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 , AP ICATI N F6R EVALUA N/IMPROVEMENTS R DhN., County Health Department / (r ental Health Section . O. Box 665 \ Mocksville, N.C. 27028 n ONSTRUC ON SHALL NOT BEGIN UNTIL IMPROVEMEN (RM�IT HAS BEEN ISSU D. Home Phone 704-492-7587 1. Permit Requested By JOHN W. BUSH Business Phone 2. Address ROUTE 1 , BOX 363A COUNTY LINE ROAD. DAVIE COUNTY [HARMONY POST OFFICE] 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair b) Privy Conventional Other Type Ground Absorption c) Sub-Division Sec. Lot No. 5. System used to serve what type facility: Housed Mobile Home Business Industry Other b) Number of people 3 6. a}If house or mobile home, state size of home and number of rooms. House Dimensions '16 X 70 Bed Rooms 3 Bath Rooms 2 Den w/Closet_ b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water-using fixtures: commodes 2 urinals garbage disposal lavatory 2 showers 2 washing machine dishwasher 1 sinks" 1 8. a) Type water supply: Public x Private Community b) Has the water supply system been approved? Yes No 9. a) Property Dimensions Road Frontage = 125 . 12 Opposite = 125' Depth = E 227/W 230 b) Land area designated to building site . 657 Acre c) Sewage Disposal Contractor 10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? NO What type? This is to certify that the information is correct to the best of my knowledge. Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: ROUTE 64—to..-Sheffield Road .- approx. 4 miles to Countyline Road. Left on Qounty_1i.ne.-.road)for 8/10 mile to first house after Edwards Rd on the right which is the residence described above. NAME ON MAIL-BOX ACROSS-THE ROAD. *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject j to revocation, if site plans or the intended use change, l Effective October 1, 1989. DCHD(6-82) �i'0%GRADY 1. T&TFROw• certify that on f{p�IL c 9 �t 19 1 surveyed the property Awmenn, this.plat," 1 that the property lines and location of all structures are accurately shown hereon; that no.structur*\Irfz �te �l�l ttper}y eeCroaches, on any adjacent street or property, and that no structure on adjacent property � �� `�1i11 '•�1'let S surveyed." =2 « SEAL. 1,,.2527 O �J A SUtiq Wim♦ 4 �:IIARt [ t /hnr Ft):uARD5 Psi. •�� Pc; t 1 _PL fir rL, 13'E —a , ttACEL t'hwr P. L INE.) \ t, � i rj-tier rl X i `W tJ. 1L IfF'•1'� ! N m ;. UB. 71 PG 55co © V) e /Al PI7 '•� � � 28.3 :r ;3�; 14 1 1 cc i ilSilN� TRo►, rJ00� 01 14 1 �Ul —+- t l�St >+� Il<ou EuS.TlAm A tROtJ ON FUGE QN EaGF Past:- PflvC, I?S.Il PAVEf� ______�____ - C S 02'.52'43' W .. "..0:,►.2YY Llau kin[; ) • S lz 1336 SUKiE:Y FOR EMI 44, J014N W. U;iII y w/ Fr ICE F=. LOT NO. MAP OF BLOCK NO. Or r D BOOK J�z� PAGE . `3 Ulillf COUNTY, N. C. TUTTEROIN SURVIVING CO, �'ntl,{Inch 10!t1N5NIV ! ROUTE b. BOX 129 F SCALE: t INCH = _—U _-11Ett-r AWMVILM N• G ,492.5616 JOB No' 4 ' goYTN[AN, INOTO PAINT • tY1•►T CO.—MIN•TON••.\1.. NM01 "Z