866 Angell Rd 7TYc'. it"'f.'7i' "Wfk+"+.�d;f�u33i'1#M:R.`_'..�:if sar5i r°rvif•Y§cw�+waer"+u„4M1;i►'"4:�r—�.�ryy..y,iw,c.�,,,t✓..��•I.'R's3'� ��''�'"a'n'"'ra"'m'P."."'4r3jJ�i�+'-await+S"�e'..'a"Yd^`
h Ax o
- DAVIE COUNTY HEALTH DEPARTMENT
1
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
Sanitary Seyyage7stern's Permit Number
.�i/J.'/17,F,(�u0 �i� '°/��!/.�� Da ��9�93 0 7143
Name—
No _
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size � House Mobile Home _T Business Speculation
No. Bedrooms �:E No. Baths No. in Family —
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO ❑
Auto Wash Ma-.hive YES NO
Type
❑ Q'��i� �l .YC/
Type Water Supply ---
*This permit void if sewage system aeseribed 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 _Ila
`—
*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 by— °
.Certificate of Completion Date L
�l
*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.
.� j_. 0 .'� ..t•+.i�`i:.*T` y '1" e¢,i t—.-.y .v: e r w .W .`+ .!.
= DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
-- - *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a
_-Sanitary.Sewage,Systems , Permit Number
_ No 7143
1 Name •-.)i:tl.I/��'�ui//�' 111 .!`���' /�U/� _Dae
All
. Location
Subdivision Name Lot No. Sec. or Block No.
s,,l C t,✓
Lot Size House Mobile Home_ Business Speculation
No. Bedrooms .No. Baths No. in Family
Garbage Disposal YES ❑ NO ❑
Auto Dish Washer YES ❑ NO ❑ Specifications for System;
Auto Wash Ma shine YES p NO ❑ �
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.
Ile, 17
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 Installed b
Iv
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. `�
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
` /✓APPLICATION FOR IMPROVEMENT PERMIT(REPAIR)
NAME��,'�/n 1/ �G/tr fY PHONE NUMBER 2V
ADDRESS �0,� SUBDIVISION NAME
LOT #
DIRECTIONS TO SITE .� </ V C fJ ✓
DATE SYSTEM INSTALLED - NAME SYSTEM INSTALLED UNDER
TYPE FACILITY NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY 4�� SPECIFY PROBLEM OCCURRING
DATE REQUESTED INFORMATION TAKEN BY���
This is to certify that the Information provided is correct to the best of my knowledge,an at I understand I am respons�for all ar as Incurred from this application.
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev.1193