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P7123 Hwy 158�...,..,r.-,7;av^w.v..j-v✓.iVssrcFw�dwf^o�.�f�t�'+""'�'a^r^iM'ir"o+r�'wavy^-'.by°f�+'Mrwcr'�iRL—.".'Y;a+'^.Y.SPS;osw�.MrtW4;.>hr.kw�+r�Y�.+r.-w ., DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE: Issued in Compliance With Article 11 of G.S. Cha p�er 130a Sanita ewage Systems V,� Permit Number 3s' r _1/lam 0 Name � , nn �' �/! Date N � 7123 Locatio �S�' !P 0nd /�'� o YUP r 4elf (��i�e l /� ��iC- Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _- Business _ Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ aa Auto Wash Ma :hive 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. l�rp�r��f 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: S 1 System Installed by v / Certificate of Completion A/1", Date4Q-3 '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. .:',tit'Y^''�:�'", -. 4i'$t• ":`; 7`�+:. r'�a •;.`i' e �z;q ,/ "fit' rt' j � i�, ��,a # r, t . F' 'F W j ' :. # '., i �/y � w DAVIE COUNTY HEALTH DEPARTMENT �\ IMPROVEMENTS PERMIT AND. CERTIFICATE -OF COMPLETION / *NOTE: Issued in Compliance With Article I I of G.S. Chater 130a _ Sanitary ewage Systems �, F Permit Number Name 1��ai?�1�, �?�.j �U% `/; ,t Date ��/N2 1 -y 2 Location a'd%- ,t — Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home ______ Business __ Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES ❑ NO ❑ Specifications for System: Auto Dish Washer YES ❑ NO ❑ Auto Wash Ma.hine YES ❑ NO ❑ /�vX � � y� 1-���� 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. r 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 v 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 YQ�wP-z PHONE NUMBER 63'! 3.5'38' ADDRESS SUBDIVISION NAME �Yjao,�do-%/lC ISG• Z7o 2�' LOT #,�,�� DIRECTIONS TO SITE �-S8 - B�-riK .�.� �.,��.,. Adla-1 lla4d W /_�L�..� ....�� l iuJ� kre- DATE SYSTEM INSTALLED NAME SYSTEM INSTALLED UNDER TYPE FACILITY NUMBER BEDROOMS 3 NUMBER PEOPLE SERVED TYPE WATER SUPPLY SPECIFY PROBLEM OCCURRING DATE REQUESTED 4el- l' 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 Rev. 1/93