153 Jolley Rd.00' dDAVIE'COUNTY HEALTH DEPARTMENT ✓�� �i- is' - p
IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION
- Permittee's
Name: LLC . �t'1� t( a. t 'T� Subdivision Name: ;
Directions to property:' ;` } Section: r + Lot:
IMPROVEMENT
1�i.. J ...�a .� t, . �' r• PERMIT Tax Office PIN :#
Road
p:`
i Name Zi � s_.�.�.K �
**NOTE** This Improvement Permit DOES NOT authorize the construction or installation of aseptic tank system or any wastewater system. An
`AUTHORIZATION FOR WASTEWATE4,SYSTEM CONSTRUCTION must be obtained from this Department'prior to the
construction/installation of a system or the issuance of a building permit.
(In compliance with Article.I I f G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems)
I j ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE
I ,` % `,. W_, i�K - ; •: ` 1 �.��m PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER
"ENVIRONMENTAIJHEALTH SPECIALIST DATE ISSUEb SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE .
INSTALLING THE SYSTEM.
RESIDENTIAL SPECIFICATION: BUILDING TYPE 1-1CaS,€ # BEDROOMS _ # BATHS # OCCUPANTS GARBAGE DISPOSAL: Yes or No
E #PEOPLE # PEOPLE/SHIFT #SEATS INDUSTRIAL WASTE: Yes or No
COMMERCIAL SPECIFICATION: FACILITY TYP
A,
LOT SIZE TYPE WATER SUPPL DESIGN WASTEWATER FLOW (GPD) NEW SITE REPAIR SITE`
-TAt, � r � '
SYSTEM SPECIFICATIONS: TANK SIZE v GAL, PUMP TANK GAL. TRENCH WIDTH .. 1. ROCK DEPTH LINEAR FT. l
OTHER
REQUIRED SITE MODIFICATIONS/CONDITIONS:
IMPROVEMENT PERMIT LAYOUT$APPROVED.-EF UEN V .LNT IR SER(S) IF 611 BELOW FINISIC-D GRADE
w-25
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- a
�.� I- ;L0
**CONTACT A REPRESENTATIVE OF THE DAVIE COUNTY H ALT EPAR MENT FOR FINAL INSPECTION OF THIS SYSTEM
BETWEEN 8:30 - 9:30 A.M. OR 1:00 = 1:30 P.M. ON THE LLATION. TELEPHONE # IS �5
(336)751-8760
OPERATION PERMIT C C
SYSTEM INSTALLED BY:
O
t
� F�Ck f r 2S
AUTHORIZATION NO. OPERATION PERMIT BY: DATE: 1 O 6q 6
**THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT TH Y DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE
WITH ARTICLE 11'OF G.S. CHAPTER 130A, SECTION .1900"SEWAGE TREATMENT AND DISPOSAL SYSTEMS", BUT SHALL IN NO WAY BE TAKEN AS A
GUARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORILY FOR ANY GIVEN PERIOD OF TIME.
DCHD 05/96 (Revised)
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AUTHORIZATION NO: AVIE,COUNTY HEALTH DEPARTMENT'
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Environmental Health Section PROPERTY INFORMATION
Permittee'sP.O. Box 848
Name: L'_L G t , �CLL I? ' �.:�� Mocksville,NC 27028 Subdivision Name:
l�t�1 `1` P3316-751-8760
bone# '
Directions to property:" -- Lot;
AUTHORIZATION FOR
' WASTEWATER
Tax Office PIN:# -
�- SYSTEM CONSTRUCTION
951
'Road Name 1--°t` --'� Zip:
**NOTE**This.Authorization for Wastewater System dristruction MUST BE ISSUED by the Davie CountyEnvironmental Health Section prior
to issuance of any Building-Permits This FoRtt/Authorization Number should be presented to the Davie CountyBuilding Inspections<
Office when applying for Building Permits.'
(In compliance With e 1 I'' f G.S.Chapter 130A;Wastewater Systems,Section.1900 Sewage Treatment and Disposal Systems)
***NOTICE***THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION
"IS VALID FOR A PERIOD OF FIVE YEARS.;"
[RONM T,L EALTH SPECIALIST DATE ISSUE