111 English Ln DAVIE COUNTY HEALTH DEPARTMENT � C
1"► IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name Y,,, ,�r i ,� � `_ „: Date
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Location -7~ a
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business Speculation
No. Bedrooms 2- No. Baths I No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES Ey NO F] ..", - _
Auto Wash Machine YES ❑ ❑- NO i ,
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
1
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Improvements permit by
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*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
.� N,
L '` L
ys �
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 COUFTY HEALTH DEPARTHEUT
ENVI-RONIMITAL HEALTH SECTION
SOIL/SITE EVALUATIOI? f lei
t?AIS c!/l/Lluc K4 -,�.�2T DATE 3
ADDRESS ,P./ 3 B4 ( c7
LOCATIO'14 G VLA
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LOT SIZE
TOPOGRAPHY: S Sk6fa:c— CLQ :7
SOIL
SOIL TEZTURE: PS
SOIL STRUCTURE:5
DEPTH:.
RESTRICTIVE HORIZOVS:
PERCOLATION RATE: Presoak Idark,& time Drop Time Pate iiin. Inch
3.
***CLASSIFICATIOT•
Suitab Provisionally Suitable Unsuitable
C0111EITTS:
SAA?ITAT<IAI?
SITE DIAGrMf
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