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176 McDaniel RdDavie County. NC Tax Parcel Report 1W J Friday, September 30, 2016 WA"I.N16: l'HIN lS NUT A SURVEY Parcel Information Parcel Number: G70000014202 Township: Shady Grove NCPIN Number: 5870233284 Municipality: Account Number: 7307500 Census Tract: 37059-803 Listed Owner 1: BLANCO LUIS ANTONIO Voting Precinct: WEST SHADY GROVE Mailing Address 1: 176 MCDANIEL ROAD Planning Jurisdiction: Davie County City: ADVANCE Zoning Class: DAVIE COUNTY R -A State: NC Zoning Overlay: Zip Code: 27006-7029 Voluntary Ag. District: No Legal Description: .663 AC MCDANIEL RD Fire Response District: ADVANCE Assessed Acreage: 0.66 Elementary School Zone: SHADY GROVE Deed Date: 11/1997 Middle School Zone: WILLIAM ELLIS Deed Book / Page: 001980546 Soil Types: GnB2,GnC2 Plat Book: Flood Zone: Plat Page: Watershed Overlay: DAVIE COUNTY Building Value: 94730.00 Outbuilding & Extra 4640.00 Freatures Value: Land Value: 25000.00 Total Market Value: 124370.00 Total Assessed Value: 124370.00 161 Davie County, 7���'r 1\ C All data is provided as Is without warranty or guarantee of any kind either expressed or Implied including but not limited to the Implied warranties of merchantability or fitness for a particular use. All users of Davie County's GIS website shall hold harmless the County of Davie, North Carolina, Its agents, consultants, contractors or employees from any and all claims or causes of action due to or arlsing out of the use or Inability to use the GIS data provided by this website. AUTHOR rAjTQN NO: s V 9 -) DAVIE�COUNTY'HEALTH DEPARTMENT ce,:7t � �a J116rr1.5 - 1-%ook" Environmental Health Section PROPERTY INFORMATION E� Permitt e' f P.O. Box 848 - 1 /`"<d l - ri �0-1�`�"��,l� Name:_*:" °�r +. Mocksville, NC 2702E Subdivision Name: 4,1� 1� Phone #: 704-634-8760 0- Directions to property: // Section: Lot: AUTHORIZATION FOR r� r'✓ e WASTEWATER Tax Office P N:4t - �- SYSTEM CONSTRUCTION ,� T Road Nate/°�lC.: ',Aq/J/eGZip **NOTE** This Authorization for Wastewater System Construction MUST BE ISSUED by the Davie County Environmental Health Section prior to issuance of any Building Permits. This Form/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Permits. (In compliance with Article 11 of 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. ENVIRONMENTALHEALTH SPECIALIST DATE ISSUED .. •'e. ,,,,�,. - ' L . •F ( 1. ; �. i � :� 4' j"' 1 ... I r i .°rt l S-. y.S - ° .:7 ,,rrr�:(i DAVIE COUNTY HEALTH DEPARTMENT t� . f 1 r 6° . } ; <• r" = a>) �" f 'IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION :1 i1 Pei ittCC'$ f i y . ► s9 •, �t. ` 7 1..� i , - .:i / Name: f`*' '°`3}°� r•',�r^.T'/,.''' Subdivision Name: L ✓ .• + ; Directions to property: f� ��' f �,'r,; - : i .�'' �i Section: Lot: IMPROVEMENT l� PERMIT Tax Office PIN:#'JI% Road Name.t f � /,"It'/,p: **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER 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 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE e ry, PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE # BEDROOMS ? # BATHS -Z # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE /rr_ TYPE WATER SUPPLY / U DESIGN WASTEWATER FLOW (GPD)1- e/, NEW SITE /- REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE/GAL. PUMP TANK GAL. TRENCH WIDTH. C/ ROCK DEPTH P LINEAR FT. REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT *"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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT SYSTEM INSTALLED BY: '�-�j ? •�/✓'/Z."1 )J�i�at/�1 I/ ), 10 AUTHORIZATION NO. Q OPERATION PERMIT BY: + DATE:.. tf ' "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM 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) ,w tt $r, F�" .:. ✓; .,; il�; �:. F� fi''.'F 1=' tfi" E ti,j " w `,, " Ott :DAVIE COUNTY HEALTH DEPARTMENT ';.IMPROVEMENT AND OPERATION PERMITS PROPERTY INFORMATION ? Permlftc.'e's � � � ,� _ �... �. � • , t_ �. f:_ ; � _ r:.�: r Jx'� ` j ;` y .�;1 x ,1 � • r � o Name:-, Subdivision Name: - Directions to property: Section: Lot: x -x ���Cr ,a�>/, IMPROVEMENT" a'`�Ef a')'� �'"r r PERMIT Tax Office PIN:# { Road Name rEE /Ib•: Zip; **NOTE** This Improvement Permit DOES NOT authorize the construction or installation of a septic tank system or any wastewater system. An AUTHORIZATION FOR WASTEWATER 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 11 of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) ***NOTICE*** THIS PERMIT IS SUBJECT TO REVOCATION IF SITE } '`r' r'r PLANS OR THE INTENDED USE CHANGE. YOUR WASTEWATER ' ENVIRONMENTAL HEALTH SPECIALIST DATE ISSUED SYSTEM CONTRACTOR MUST SEE THIS PERMIT BEFORE INSTALLING THE SYSTEM. RESIDENTIAL SPECIFICATION: BUILDING TYPE _ # BEDROOMS �,? # BATHS 19 # OCCUPANTS GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No j ! F - ,r LOT SIZE 1(7e1;9 < TYPE WATER SUPPLY �' DESIGN WASTEWATER FLOW (GPD) ''`/l NEW SITE—Lf REPAIR SITE 1 SYSTEM SPECIFICATIONS: TANK SIZE%, '�''I) GAL. PUMP TANK GAL. TRENCH WIDTH._ f l " ROCK DEPTH /f LINEAR FT. J C: REQUIRED SITE MODIFICATIONS/CONDITIONS: IMPROVEMENT PERMIT LAYOUT "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 THE DAY OF INSTALLATION. TELEPHONE # IS (704) 634-8760. OPERATION PERMIT ��r �f J` yYfi•'r 7 �! SYSTEM INSTALLED BY:�~ f' Adb l� Qr' ? AUTHORIZATION NO. � OPERATION PERMIT BY: tJ DATE: "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM 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) ,APPLICATION FOR SITE EVALUATIONAMPROVEMENT PE . ,7 r •r Davie County Health Department D S `_' `-- Environmental Health Section P.O. Box 848 OCT 8 loO- Mocksville, NC 27028 (113 4- (704) 634-8760 _(704)634-8760 ****IMPORTANT**** THIS APPLICATION CANNOT BE PROCESSED UNLESS ALL THE REQUIRED INFORMATION IS PROVID`E,D�.Y1 1. Name to be Billed �ns r4- ' � 4 CA " �nS � • Contact Person pM t Ke l � � Orr I'S an Mailing Address Cgl? . / n n � �—ES-7-2� Home Phone / /o - 958-2-10 City/State/Zip f� IOC,K•S (1 i 1' e G 1%2_&� Business Phone 2. Name on Permit/ATC if Different than Above Mailing Address 3. Application For: [ Ate Evaluation City/State/Zip [ ] Improvement Permit & ATC [ ] Both 4. System to Serve: [kfHouse [ ] Mobile Home [ ] Business [ ] Industry [ ] Other 5. If Residence: # People # Bedrooms a # Bathrooms -7 [ f Dishwasher [ ] Garbage Disposal [ YWashing Machine [ ] Basement/Plumbing [ ] Basement/No Plumbing 6. If Business/Other: Specify type # People #Sinks # Commodes # Showers # Urinals # Water Coolers If Foodservice: # Seats Estimated Water Usage (gallons per day) 7. Type of water supply: [►/County/City [ ] Well [ ] Community 8. Do you anticipate additions or expansions of the facility this system is intended to serve? [ ] Yes [ rgo If yes, what type? PROPERTY INFORMATION REQUIRED: *** IMPORTANT ***,��T OF THE PROPERTY MUST BE SUBMITTED WITH THIS APPLICATION. Property Dimensions: 66 act WRITE DIRECTIONS (from Mocksville) TO PROPERTY: Tax Office PIN: #59-70 - e-3 _ 3 Z g'4 (D 4 L on 001-ovifr'12J� , r Property Address: Road i�ame ; 6 � DA., , OL� 0/1 /�y' i L Ji,, r 6L •CCl ' U/7 e(QA l ✓1 i v'am N c Z200.6 ; Ourae City/Zip ��� , If in Subdivision provide information, as follows: Name: Section: Lot #: ; This is to certify that the information provided is correct to the best of my knowledge. I understand that any permit(s) issued hereafter are subject to suspension or revocation, if the site plans or intended use change, or if the information submitted in this application is falsified or changed. I, also, understand that I am responsible for all charges incurred from this application. I, hereby, give consent to the Authorized Representative of the Davie County Health Department to enter upon above described property located in Davie County and owned by, J(1S�'h QA���Ii[CYi 1'i _ �d, to conductall ;temstMrres as necessary to determine the site suitability. DATE �48% % I SIGNATURE Revised DCHD (06-96) THIS AREA MAY 13E USED FOR DRAWINC7 JOUR SITE PLAN: DAVIE COUNTY HEALTH DEPARTMENT .. Environmental Health Section SECTION LOT Soil/Site Evaluation APPLICANT'S NAME N O Z94 11 DATE EVALUATED PROPOSED FACILITY PROPERTY SIZE SUBDIVISION ROAD NAME Water Supply: On -Site Well Community Public Evaluation By: Auger Boring Pit I Cut FACTORS 1 2 3 4 5 6 7 Landscape position L L Slope % HORIZON I DEPTH Texture group Consistence Structure Mineralogy HORIZON II DEPTH t' Texture group Consistence 41 Structure Mineralogy/ HORIZON III DEPTH Texture group Consistence Structure Mineralogy HORIZON IV DEPTH Texture group Consistence Structure Mineralogy SOIL WETNESS RESTRICTIVE HORIZON SAPROLITE CLASSIFICATION LONG-TERM ACCEPTANCE RATE I V SITE CLASSIFICATION: LONG-TERM ACCEPTANCE RATE: REMARKS: Zl(,SP LEGEND DCHD (01-90) EVALUATION BY: !4 l OTHER(S) PRESENT: `lte Landscape Position R - Ridge S - Shoulder L - Linear slope FS - Foot slope N - Nose slope CC - Concave slope CV - Convex slope T - Terrace FP - Flood plain H - Head slope Texture S - Sand LS - Loamy sand SL - Sandy loam L - Loam SI - Silt SICL - Silty clay loam SIL - Silty loam CL - Clay loam SCL - Sandy clay loam SC - Sandy clay SIC - Silty clay C - Clay CONSISTENCE Moist VFR - Very friable FR - Friable FI - Firm VFI - Very firm EFI - Extremely firm Wet NS - Non sticky SS - Slightly sticky S - Sticky VS - Very Sticky NP - Non plastic SP - Slightly plastic P - Plastic VP - Very plastic Structure SC - Single grain M - Massive CR - Crumb GR - Granular ABK - Angular blocky SBK - Subangular blocky PL - Platy PR - Prismatic Mineralogy 1:1, 2:1, Mixed Notes Horizon depth - In inches Depth of fill - In inches Restrictive horizon - Thickness and inches from land surface Saprolite - S(suitable), U(unsuitable) Soil wetness - Inches from land surface to free water or inches from land surface to soil colors with chroma 2 or less Classification - S(suitable), PS(provisionally suitable), U(unsuitable) LTAR - Long-term acceptance rate - gal/day/ft2 ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■ ■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■ONE ■■■■■■■■■/■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■ ■■■■ ■■ ■■■■ ■■■■ ■■■ ■■■■■■■■■■■■■■■■■■■■ ■■■ ■■■■■ ■ ■■■■■ ■■■■■■■■■■■■■■■■■■■■■w■■■■■■■■■Nil■■■■■■■■■■■■■■■■■■■■■■■■ MEMNONMENNENENNEINE MESEEM®EMEMEMNEEMEMNEEMEM ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■■ ■■■■■■■■ ■■■mono■ ■■■■NEEM ■■■■■■■■ ■m■■mm■■ ■■■■■■ ■■■■■■ ■■NEEM ■■■■■■ ■■■■■■ ■E■■■■ ■■■■■■ ■■■■M■ ■■■■■■ ■■■■■■■■ ■■■■■■■■ ■■■■NESE ■■■M■■■■ ■■■■■■■■ ■■■■NEEM ■■■NESE■ ■■■■■■■■ ■■■NEEM NEEM■■■ NEEM■■■ ■■■NEEM ■■N■■■■ NOME NEEM NOME NONE NONE NEON MEMO NEON MEMO ■■NEEM■■■■ SEES■■■■■■ ■■■■■■■■■■ ■■NEEM■■■■ MENS■■■■■■ Davie County Health Department X18 1 mental Health Section ;. s P.O. Box 848 O 210 Hospital Street' O µ Courier # : 09-40-06 1911 BYi_-�» Mocksville, NC 27028 Phone: (336) - 753 - 6780 ON-SITE WASTEWATER CERTIFICATION Fax: (336) - 753-1680 (Check One) Replacement Remodeling Reconnection S 33� — Goa—O/yb (Home) Name: v� �Q C Phone Number Mailing Address: tZ d V1 I I (Work) /7d VoP7Gr�. Email Address: IulS1�/ 1/Cic� %�ot®lPi• Tl� Detailed Directions To Site: '`7 f (. �/l/Ia7 ('/G Q l ,� 6 6 cti�1,101joAliul Property Address: P7& lllell� liyil -/ K Please Fill In The Following Information About The EXISTING Facility: Name System Installed Under: LU IS Sb a (' v Type Of Facility: US6 Date System Installed (Month/Date/Year): �"/ 7Number Of Bedrooms: k, Number Of People: i5 Is The Facility Currently Vacant? Yes Any Known Problems? Yes 60) 60) If Yes, For How Long? If Yes, Explain: Please Fill In The Following Information About The NEW Facility: Type Of Facility: �Ale '�—r? 4 Number Of Bedrooms: Number of People Pool Size: Garage Size: X Ll Other: /Requested By:��/;'S R)jIe vc Date Requested: (Signature) For Environmental Health Office Use Only Approved Disapproved Comments: Environmental Health Speciali Date: *The signing of this form by the Environmental Health Sfaff is in no way intended, nor should be taken as a guarantee (extended or limited) that the on-site wastewater system will function properly for any given period of time. Payment: Paid By:_ Account #: Order # 60X9/' Amount:$ Received By: Invoice #: L4 Date: :�—`"�.�_ ,,, � � � �`� r - _ . '� � �.... ```..,�. � �"'": �' ..,... ..{`-.... /j }S �i'��;�.., �j�--i,�~ u/,� �� � � ���� �:` �.: ,s. '"""��...._ , � �,� Y��+�,� ""� I �' � S � �..,,.,,,,,�. / •�^-�-_.`..'""- -.-.. .,-....,,�I' � ,r�� ��' "'O. � . f `y � ( h'+�ed"F� �'� ` t �W � � �......_�C�F��,�~ � � . }�� �'��. + � +� r� �� �;` �� i � �` � � 5, � � � � , � , ; ; � ; .� ; ; �,-. � r � �� ? � �`�•.�,f"�._,�__—...�... a�� � 3 , � t ; { ; �� ,' f j � � ? �, �. j ; _;. � �o`��t' f �d1 i ' J✓ ' �1, #3',' � ' V�' Y `,�'1� � 1 � %,,, i( A., � 1 .��C .�� , �� � s �- � i i�-,- !� ` �� ��� �1 i r � ; � � �� , � � , , � , � � I s� �-��.�= ' ` lK � , �,,� ; , , r ; ' ; ' ` �' �`''`k'� , f ' � � --- . � .— � ' ; � ���°� � __� _.. + � � 1 , �_..__�._ � �.,. '� � - _.._ , f � _ __- , _ _ _ d ," ` � "" � � __-.f— �- � � _ _ . - � � � 3� r _._- - z. ` " - �, _ . _ _ _ � _ _ _ , -_ ,-- Map Frame I . I Page I of I Davie -County, NC - GIS/Mapping System Click Here To Start Over Quick Search:(CcunLy ID or Oviner Ni 0 Active Layen TI.D.Ma5 PARCELS (Map Tips Available) Addro MIIAILITj ImInc Vw -1 G704000-61 LOT dS SEC I 0 o i 02ft http://maps.co.davie.nc.us/GoMaps/map/mapframe.cfm?CFID=4129&CFTOKEN=61640... 12/29/2011 o� DAVIE COUNTY HEALTH DEPARTMENT �IIIfIMOVEMENTS PERMIT AND CERTIFICATE OF COMPLETION NOTE;�ssued in Compliance with G.S; of North Carolina Chapter 130 Article 13c :gig` .Sewage Treatment and Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name i` L r ;. i'/ Z, /. L Date =�� / ` N- Location ion Name Lot No. Lot Size -`%<� House4�_ Mobile Home _ Business Speculation k' r No. Bedrooms `_ No. Baths No. in Family 42. L Garbage Disposal YES C] NO 0- Specifications for System:/r Auto Dish Washer YES p --NO ❑ Auto Wash Machine YES e NO ❑ Type Water Supply 'This permit Void if sewage system described below is not installed within 36 months from date of issue. I 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 by / 4 r'_%.. Certificate of Completion " _Date 4, Certificate "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.