P2938 Dalton Rd - ' ' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
"Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
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Name �' ,( r i 'r. �; Date
Location -j, �T , __ +� C i► - C. , i _ 4.- �; C? w i�– L-A.—
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Subdivision Name 7 Lot No. Sec. or Block No.
Lot Size ' ���'�- House ` Mobile Home — Business -- Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO p' Specifications for System: `v,-n
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES..p' NO ❑
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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
Final Installation Diagram: System Installed by
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Certificate of Completion - Date
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'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.
M
DAVIE COUM HEALTH DEPARTHENT
EDIVIROYI-MITTAL HEALTH SECTION
SOIL/SITE EVALUATIOV
PAIS DATE 3 31 -V 2
ADDRE S S 3 i o rw, 11
Moc.k,Su: j� LOCATION T✓IzKT-/1c r� i?�-
LOT SIZE—
TOPOGRAPHY:
IZETOPOGRAPHYe �15
SOIL TEiiTURE s
SOIL STRUCTURE o/Ps
DEPTH o !�-S
RESTRICTIVE HORIZOES>
PERCOLATION PATE: Presoak Hark & time Drop Time Rate/iiin. Inch
3 bd�• l' �
1 dk�� eo. azo 2.
Nd
3. C
***CLASSIFICATIO11:SuitableProvisionally Suitable Unsuitable
COMMENTS:
SANITARIAN In Awoe
SITE DIAGFAYI
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