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334 Potts Rd (2) DAVIE COUNTY HEALTH DEPARTMENT :I ._ IMPROVEMENTS PERMIT AND- CERTIFICATE OF COMPLETION f " ` *Note: Issued*in'Compliance with G.S. of North Carolina Chapter 130—Article 13c. Permit Number Name ,i%%,��} Date r .. Location Subdivision Name Lot No. Sec. or Block No. Lot Size House Mobile Home _ Business Speculation No. Bedrooms yJ No. Baths No. in Family - Garbage Disposal YES ❑ NO p'' Specifications for System: Auto Dish Washer YES © NO ❑ /� <� �• . Auto Wash Machine YES ❑ 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 *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, J 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 COUNTY HEALTH DEPARTMENT Environmental Health Section R O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION ` Name Date Z��` Address Lot Size/' lf/15-a)- FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position S S S S PS PS 2) Soil Texture (12-36 in.) Sandy, S S S S Loamy, Clayey, (note 2:1 Clay) PS PS U U U U 3) Soil Structure (12-36 in.) S S S S Clayey Soils t:::� --- PS PS U U U 4) Soil Depth (inches) S S S S PS PS U U U U 5) Soil Drainage: Internal S S S S � PS PS U U U U External � S S PS PS PS PS U U U U 6) Restrictive Horizons 7) Available Space - S. S S PS PS U U U U 8) Other (Specify) S S S S PS PS PS PS �U U U U 9) Site Classification v. U—UNSUITABLE S—SUITABLE PS—Prov�onally Suitable Recommendations/Comments: Described by � Title ,mow` Date SITE DIAGRAM DCHD(6-82) APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT 43 Davie County Health Department (' Environmental Health Section R 0. Box 665 Mocksville, N.C. 27028 i CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone -ate/o z� 1. Permit Requested By %