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187 Elm Street Lot 69 PO 68Permittee's .' Name: " '' ' DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section Pd- 9oPROPERTY INFORMATION tn Directions to property: ?`: i; ' ; (� P.O. Box 848 Mocksville, NC 27028 Subdivision Name: Phone #: 336-751-8760 Section: Lot: AUTHORIZATION FOR 4 WASTEWATER Tax Office PIN:# - - LI SYSTEM CONSTRUCTION 3; AUTHORIZATION NO: 0 0 2 C? 4 0 A /,; , N Road Name �' � /}? r � Zip: **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 Fonn/Authorization Number should be presented to the Davie County Building Inspections Office when applying for Building Pen -nits. (In compliance with Article 1 I of G.S. Chapter 130A, Wastewater Systems, Section .1900 Sewage Treatment and Disposal Systems) r ' ***NOTICE*** THIS AUTHORIZATION FOR WASTEWATER CONSTRUCTION IS VALID FOR A PERIOD OF FIVE YEARS. ENVIRONMENTAL HEALTH -SPECIALIST DATE ISSUED �� RESIDENTIAL SPECIFICATION: BUILDING TYPE t 1 # BEDROOMS _ # BATHS # OCCUPANTS _Z_ GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS _ INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY LD, DESIGN WASTEWATER FLOW (GPD) 3(0 NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE' �AL. PUMP TANK GAL. TRENCH WIDTH �l ROCK DEPTH N/�} LINEAR FT. n-, Pct. REQUIRED SITE MODIFICATIONS/CONDITIONS: Av +Y(001 Ct('. IAa1 2-4" IMPROVEMENT PERMIT LAYOUT rnre� bt EU�c bey--mki . Vli\c - 3" 1,%VC vocky 6640. IIFOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. 1 OPERATION PERMIT 1 Z,\V. d"f A SYSTEM INSTALLED BY:kr, S N1L►Y�.�^ ` Jia h N M0T,Fr,4- yd Fit t q tkab.Cw1.1:� u�U3- f - o polevvm /,,,NI Xu. AUTHORIZATION NO. 2' I 4b 4 OPERATION PERMIT BY: DATE: 5-p I Lo "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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 02/02 (Revised) f1 4 LI 3; AUTHORIZATION NO. 2' I 4b 4 OPERATION PERMIT BY: DATE: 5-p I Lo "THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE WITH ARTICLE I 1 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 02/02 (Revised) f1 Permitteee's ? DAVIE COUNTY HEALTH DEPARTMENT Name; 16' — -; t = Environmental Health Section PROPERTY INFORMATION 51� P.O. Box 848 Directions to property: " Mocksville, NC 27028 Subdivision Name 1 1. k 1_. -. `; c , Phone #: 336-751-8760 AUTHORIZATION FOR ; t WASTEWATER A SYSTEM CONSTRUCTION AUTHORIZATION NO: 002940 A Section: Lot: Tax Office PIN:# - - Road Name: t . i Zip: -7 **NOTE** This Authorization for Wastewater Svstem 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 0 3trtlding Permits. (In compliance with Art`l'.A.l-6f 6.: ."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. ENVIRONMENTAL HEALTH, SPECIALIST t ti'+ tDATE;ISSUED ! t . 1 RESIDENTIAL SPECIFICATION: BUILDING TYPE " r-, # BEDROOMS # BATHS .w # OCCUPANTS Z GARBAGE DISPOSAL: Yes or No COMMERCIAL SPECIFICATION: FACILITY TYPE # PEOPLE # PEOPLE/SHIFT # SEATS INDUSTRIAL WASTE: Yes or No LOT SIZE TYPE WATER SUPPLY C�7. DESIGN WASTEWATER FLOW (GPD) 5{SC) NEW SITE REPAIR SITE SYSTEM SPECIFICATIONS: TANK SIZE GAL. PUMP TANK GAL. TRENCH WIDTH '�n ROCK DEPTH N �) LINEAR FT. ( 1 REQUIRED SITE MODIFICATIONS/CONDITIONS: ! "��� X �i I�l _�� r� 1' �rt'1 7.4 ti IMPROVEMENT PERMIT LAYOUT - t C�1AIC 4� n 4 ' \ R' N FOR FINAL INSPECTION OF THIS SYSTEM PLEASE CALL BETWEEN 8:30 - 9:30 A.M. ON THE DAY OF INSTALLATION. TELEPHONE # IS (336) 751-8760. V OPERATION PERMIT 5 �U�cD Il�` yrlU �? to Z\I„��1 SYSTEM INSTALLED BY: SilG1\ _ —obT 1'r-4- V Zk L� _4.t,�1•� _ t tq(I�� vc 1 I.,L AUTHORIZATION NO. 2 y `� OPERATION PERMIT BY: DATE: 5 U *"THE ISSUANCE OF THIS OPERATION PERMIT SHALL INDICATE THAT THE SYSTEM DESCRIBED ABOVE HAS BEEN INSTALLED IN COMPLIANCE. WITH ARTICLE I I 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 07/02 (Revised) IN V J) DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION APPLICATION FOR IMPROVEMENT PERMIT (REPAIR) 1, NAME . IIIA �D PHONE NUMBER 7J��' �1 ADDRESS 191 QmSUBDIVISION NAMEI'VL )J1 I ' '\/- LOT # b q /P01 � S - 39- 411 DIRECTIONS TO SITE US 151 Ct_4 R In DATE SYSTEM INSTALLED ? NAME SYSTEM INSTALLED UNDER-- TYPE NDER- TYPE FACILITY NUMBER BEDROOMS 5 NUMBER PEOPLE SERVED TYPE WATER SUPPLY Mkh I (' Zpg SPECIFY PROBLEM OCCURRING f J'1k Q -has E n © T 1 a u,i\ u ( I x GYfLi%1.9 ( AAm 1b us4n, iso' 4 -ark) DATE REQUESTED3-1(-oq INFORMATION TAKEN BY, This is to certify that the information provided is correct to the best of my knowledge, and that I unde _ SIGNATURE OF OWNER OR AUTHORIZED AGENT Rev. 1/93 q -lb,oq eolled Ae{i{ messy q lo J/ GoMAPS - Davie County NC Public Access Page 1 of 1 Davie County, NC - GIS/Mapping System Click Here To Start Over Quick Search:(County ID or Oviner Ni Active Laycr. EjUsellitpUps Eq 0 0*(Map Tips Available) Addre http://maps.co.davie.nc.usIGoMapslmapllndex.cfm?maimnapservice=gomaps&CFID=412... 3/12/2009