145 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. r
Permit Number
Name��12//_NcK ow < � Date (73 0
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Location —
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Subdivision Name Lot No. Sec. or Block No.
Lot Size./O 0 y 5 House �-� Mobile Home — Business Speculation
No. Bedrooms 3 No. Baths No. in Family—'Z=—
Garbage Disposal YES ❑ NO Specifications for System: 900 'z jj�
Auto Dish Washer YES ► NO ❑ i . i' (1
Auto Wash Machine YES j NO ❑ foo A 3 �k' I$ S';vN£
Type Water Supply —IL j -- _/D IS1171 CI-1- (0AJC/Z�-7
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*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
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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 bye ^
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Certificate of Completion � ��Min Date]i -
*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.
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DAVIE COTFTY HEALTH DEPARTHEUT
w `` G t5- 'q -T-kvrZsaay ENVI30111.01TAL HEALTH SECTION
SOIL/SITE EVALUATIOU
I1AI�lE V(LN�,fL N Q��� DATE
ADDRESS /23 , 1
G�Jt/C�Gf A lV LOCATION %U424fA-trNC C(4-
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LOT SIZEO t� 3�
TOPOGRAPHY: S
SOIL TE2.TURE: StGTy Gc y
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SOIL STRUCTURE:
DEPTH:
RESTRICTIV'3 HORIZOIIS: $•�F J/4) y5� r
PERCOLATION RATE: Presoak Hark & time I Drop Time Pate/ lin. Inch
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3. 7
**CLAS SIFICATIOt1:
Suitable Provisionally Suitable Unsuitable
COlli MITS:
SANITARIAII ��--
SITE DIAGRAIM
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