1372 Point Rd (2) �=" • 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 _ _ - - Date ,04 r
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size %'r'" House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES !p NO p Specifications for System:
Auto Dish Washer YES E] NO C7
Auto Wash Machine YES p NO C]
Type Water Supply
`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
*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 -7tJA'I Z V-
Certificate of CompletionnYiT Date v
*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 COUNTY HEALTH DEPART IE TT
ENVIR01,11JENTAL HEALTH SECTION
SOIL/SITE, EVALUATIOIT
ITAIRE DATE zz a
ADDRESS /2 .
LOCATIO:T
LOT SIZE
TOPOGRAPHY:
SOIL TE;,TURE:
e :
SOIL STRUCTURE:
DEPTH: �
RESTRICTIVE HORIZONS:--�,,49,11c--
PERC AT
LATI 1111 RE: Presoak Mark & time Drop Time Pate/Hin. Inch
X64:5 �� 1. dv
2.
U 3.
***CLASSIFIellIOPTs 1 2b a Provisionally Suitable Unsuitable
COIBIEITTS:
SANITARIAII
.SITE DIAGPA
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