150 Raintree Road Lot 25DAVIE COUNTY HEALTH DEPARTMENT
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IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'NOTE: Issued in Compliance With Article 11 of G.S. Chapter 130a
Sanitary Sewage Systems �` ° %��"` ' Permit Number
Name (1'i f' �� f�/GJ n% Date '. N2
7928
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Location _
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 NO p Specifications for System:
Auto Dish Washer YES NO ❑
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
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM,
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22�.y-oyl') //
Improvements permit by—�/i`i2L—
•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^. $ /ED
Final Installation Diagram:
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System Installed by
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Certificate of Completion h e -- 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.
PIX 0
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
Name _� ,� : / - %%;' /F%� ,': ,�_- t Date N2 7928
Location
Subdivision Name y %=` 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 NO ❑ Specifications for System:
Auto Dish Washer YES NO ❑ rI
Auto Wash Ma^hine YES NO ❑ Z)6 't
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
ATTENTION: YOUR SEPTIC SYSTEM CONTRACTOR MUST SEE THIS PERMIT/LAYOUT BEFORE INSTALLING THIS
SYSTEM.
Pv�
411"1` 4/1 GI �.L�
00 Y
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Improvements permit by —/`1 --
•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.S'
Final Installation Diagram
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System Installed by 1_
i
Id
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Certificate of Completion( GSL/ �_ 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.
0, DAVIE COUNTY HEALTH DEPARTMENT
f (Septic Tank) Improvements Permit and Certificate of. Completion
(.Ground Absorption Sewage.Disposal System G.S.-Chapter-130-Article 13C)
OWNER OR CONTRACTOR . DATE. v}'�,; PERMIT
LOCATION ' i.!_^<<,; x,c h +�«�.•! l�-.1866
S.R. NO.
SUBDIVISION NAME; f*• LOT -NO.,' �5 SECTION OR BLOCK N0.
ttuust; l_J MUISILL. HU U. BUSINESS ❑
N0. , BEDROOMS NO. .BATHROOMS'
GARBAGE DISPOSAL UNIT YES C].' NO
AUTO. -nISHWASHER YES Q`f NO ❑
AUTO. WASH. MACHINE YES NO ❑
SITE SUITABLE`. YES Q NO ❑
.SIZE OF TANK _ gal.`
NITRIFICATION FIELD sq._ fte
DEPTH OF STONE -IN LINES: '
... L .
WATER SUPPLY: Individual ' ❑ ; Public ❑
IMPROVEMENTS PERMIT BY,j.;,
House Trailer 800 Gal. 400 Sq. -Ft.
Two Bedroom House 800 Gal. 600 Sq. Ft.
Three Bedroom House 900 Gal. 900 Sq. Ft.
Four.Bedroom House 1000 Gal. 1200 Sq. Ft.
INSTALLED BY•
,.
DAVIE COUNTY HEALTH DEPARTMENT
P. 0. BOX 57
MOCKSVILLE, N. C.
27028
(704) 634-5985
Statement for Septic Tank Improvement Permits
and/or Site Evaluations /
NAME �Y,L Q.: � - �G DATE ISSUED
ADDRESS PERMIT NO. -
Explanation of charge
AMOUNT DUE � , SANITARIAN
PLEASE REMIT THE ABOVE A14OUNT ON RECEIPT OF THIS STATEMENT.
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1.30
DAVIE COUNTY ENVIRONMENTAL HEALTH SECTION
APPLICATION FOR IMPROVEMENT PERMIT (REPAIR)
NAME A '10 t_S � W acj � Rk N !,-e PHONE NUMBER 9U
ADDRESS 1150 R. SUBDIVISION NAME
O C'6 LOT #
17
DIRECTIONS TO SITE---J-S-<6
DATE SYSTEM INSTALLED CL Z0 -%—NAME SYSTEM INSTALLED UNDER
TYPE FACILITY 1��"�� NUMBER BEDROOMS NUMBER PEOPLE SERVED
TYPE WATER SUPPLY a U ��� SPECIFY PROBLEM OCCURRINGa1S�,,.,r..
DATE REQUESTED > >-'6 -'i y INFORMATION T
This is to certify that the information provided is correct to the best of my knowledge,
SIGNATURE OF OWNER OR AUTHORIZED AGENT
Rev. 1/93