P7585 Main Church Rd r�4 asq �*' fa�,,.{� .. -�'��r3r q.=..is-«'-w'h+Y'F�Yli,ai4j�°Til�t `'W`' d. `"l.,.-.._,�.:;ri�1,�� _ - p
0J d �€`' T'$ 9 s�i.T �`i y M+v1Wr'KY:.i �..y�1,i .s.0 .i4,dc -c tir,. �;�tv4: �,,. r r •tn::s
fid, .' ✓xo
= 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 / ! / Permi
t
Number
Name J L- � dr l�LY/Yll //�v.Il Date �!� No 1 5 8 5
Location �XIIIV- //
Subdivision Name Lot No. Sec. or Block No.
Lot Size 1,252 EZU House Mobile Home _ _ Business -- Industry
No. Bedrooms r No. Baths -37 No. in Family�_ Public Assembly Other
Garbage Disposal YES p NO •
. NO p Specifications for System:
Auto Dish WasherYES
g /PDd(1�.s�
Auto Wash Ma thine YES NO p CY
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.
h
T
I
t /
Improvementspermit 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
11111'
Certificate of Completion Date �� u
*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.
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 �fdr �t ,/?��f� ,/f_�v,l� Date �!P./Q�/ N2 f 5 O 5
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home - Business __ Industry
No. Bedrooms / No. Baths —,?--
No. in Family -el = Public Assembly Other
Garbage Disposal YES ❑ NO g' Specifications for System:
Auto Dish"Washer YES I NO ❑
Auto Wash Ma,hine YES NO ❑ ^ „
Type Water Supply /,Pl-A/
*This permil\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.
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 _�
2
VMIA,,
�s'
v
t _ a
Certificate of-Completion o � 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.
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
/� APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME O//I. /` PHONE NUMBERc
ADDRESS SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE
DATE SYSTEM INSTALLED l/,G�.Ay 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 I understand I am responsible for all charges incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT X Cp_��
Rev.1/93
SUNSET HILLS
PB . 2 , P. 79
B S A\ E .
5 V 50
� 7
N - G
N �uh�1Li��S 36s
.A„ G g
311 .5 ' D6u 2.87 Ac.
1442 19
44 K
4
cn W 10 6 y r 10 •
II A
10 0
geamvA 5
I GLO
Ln
C� p II v G O baCkPr' N V 4 cl
5 „
m
�� G �lollur 5 TO
10� I
42 .
46 45
175 4 3 50 49
5 54 52
55 Ln
58 57 -4
64 v�
BLn
I6 19 20 23
Ln 13 15
7 8 JQ
3. 4 N G
� I G
O
12 _I Z
G 9 10 —111
u Ci 8 ,�
r�U
1 5V
5 IJ V
CAVA
TW. GRAHAM