142-144 Cotton Ln 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
Name 7,1,,, 'P, t r t Date y/I'y z. PRE,
Location e.,01,v ""- /, :;7 :,�� i< der e�� ( .5=' i 3�) �r�,_i . 3
Subdivision Name Lot No. Sec. or Block No.
Lot Size acrd 'x lU'D House Mobile Home — Business Speculation
No. Bedrooms 2- No. Baths t No. in Family Z•
Garbage Disposal YES ❑ NO Specifications for System: ?oa
Auto Dish Washer YES ❑ NO
Auto Wash Machine YES p--NO ❑
Type Water Supply u� t ( _ ►ti r r p � ,a i• s�.. 11�,�, - N ..,.� 1w 3' .�
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
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Improvements permit by � ' • ����i�-��
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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: eAx System Installed by rJ_ ---
/
'73-e-
^^ C7 7
Certificate of Completion x i,. Date `7
*The signing of this certificate shall indicate that the system descried 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 COU'iTTY HEALTH DEPARTIM1T
ENVIR0111-MUTAL HEALTH SECTION
SOIL/SITE EVALUATIOr
VAME l-,Fpc DATE
ADDRESS 7�,Y,
M ac X. LOCATIOi1 ✓//cam aid iPe�
LOT SIZE /Ua `/z-av' _
TOPOGRAPHY: S Sa6to%[- fid%2 S.dT �a,e{P/.¢sty
SOIL TE,,TURE: PS L p
SOIL STRUCTURE, :,P S
DEPTH: 3 5f-
RESTRICTIVE HORIZOVS: 3 p
PERCOLATION RATE: Presoak Bark & time Drop Time Rate lin. Inch
2.
3.
***CLAS S IFICATIOPI:
Suitable �rovi—sionally Suitable Unsuitable
CONHEITTS:
SANITARIAN /0>.4 /�
SITE DIAGRAM
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