P2872 Sanford Ave ' 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
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Location
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Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation -
No. Bedrooms No. Baths No. in Family _
Garbage Disposal YES ❑ NO ❑-- Specifications for System:
Auto Dish Washer YES p 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.
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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
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Certificate of Completion `� Date
'The signing of this certificata 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 p riod of time.
DAVIE COUP?TY HEALTH DEPART_YENT d f
ENVIROMMENTAL HEALTH SECTION
SOIL/SITE EVALUATIOI?
VAME .Y. Lyu:n DATE
ADDRESS
LOCATIO14, S�,u�„�/� �v�,�uc
LOT SIZE /D� IX2 2a
TOPOGRAPHY: Su, a6/e ✓1P4 Sn,ll iY Y`���� J'fi
SOIL TEi�TURE: :/�- -��i;�? SD`lil� 1 -lP,�- . ��5�`c��•t -�llltS
SOIL STRUCTURE: 67'.1F
DEPTH: -Yr
RESTRICTIVE HORIZOUS:
PERCOLATION RATE: Presoak I•iark & time DropTime Pate iiir. Inch
3.
CLASSIFICATIOII:
Suitable Provisionally Suitable , Unsuitable
COIZf:-IEUTS:
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SANITARIATT
SITE DIAGF-4111
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