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324 N Pino Rdrt bAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION NOTE: Issued.,in Compliance With Article II of G.S. Chapter 130a Sanitary Sewage Systems Permit Number Name _Lr N�//�-1�.�.2/��5'c��/��y�s�'..�e" �(� a e a - N2 7769 Location 0 (o !N Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _� Business _� Industry No. Bedrooms �. No. Baths _ �— No. in Family �_ Public Assembly Other Garbage Disposal YES 0 NO Specifications for System: Auto Dish Washer YES ❑ NO V Auto Wash Ma.hine YES 0 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. i �t Improvements permit by. --/1/Z *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 — Vv\_ -1-S l *V - cRe U. 1 �tV .o M j Certificate of Completion 1 V 1 Date l q I *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 �,rt/�,�c�/./I�rY .�+d Date17 6 N. 9 Location S-��!/< �C� ✓ G�`- Lt ! rtl0 l� r� _ Subdivision Name Lot No. Sec. orl Block No. l Lot Size House _ Mobile Home _ Business _— Industry No. Bedrooms ,No. Baths No. in Family_ Public Assembly Other Garbage Disposal YES ❑ NO Specifications for Syste Auto Dish Washer YES ❑ NO i� Auto Wash Ma^.hine YES ❑ 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. 1 -a Improvements permit'b *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 1 LL I i f;1 Certificate of Completion OJA Date 'The signing of this certificate shall indicate that the system described above hal been installed in compliance with the standards set forth in the above regulation, but shall in NO way betaken as a guarantee that the system will function satisfactorily for any given period of time. NAM ADD DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) ONE NUMBER ' ezS BDIVISION NAME LOT # DIRECTIONS TO SITE 'Aleer DATE SYSTEM INSTALLED SPNAME SYSTEM INSTALLED UNDER TYPE FACILITY A/e/ye NUMBER BEDROOMS NUMBER PEOPLE SERVED TYPE WATER SUPPLY a/Z6 / SPECIFY PROBLEM OCCURRING DATE REQUESTED 149-1q- 2z% 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 f Rev. 1193