1491 County Line Rd \' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Nota: 'Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name ti�rLf� 0111`z Y Date 1� � Z-
Location I{ r `tit i) Z11 -/.C.
` Nun17 'J 0"V( '�. l U7 'f c.0C-i f/yvsE
c�Ni U 117-
Subdivision Name Lot No. Sec. or Block No.
Lot Size 106 ,A 2``''� House "�! Mobile Home _ - Business Speculation
No. Bedrooms 11 No. Baths 4-- No. in Family L/
Garbage Dispos I YES ❑ NO ❑ Specifications for System: /0Uv `l-
Auto Dish Wash r YES ❑ NO ❑ , U
Auto Wash Ma&ine YES ❑ NO ❑
Type Water Supply I Jf[ L U- Su ON C e/c le f 5_
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
*Contact a repr sentative 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 Installatio Diagram: System Installed by ��
Z S �--
loo'
7S
I
-� -i✓ertificate of Completion Date
*The signing of Ithis certificate shall indicate that the system describe bove 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 fo�any given period of time.
DAVIE COUPTY HEALTH DEPARTX11?T
ENVIR01,71 NTAL HEALTH SECTION
SOIL/SITE, EVALUATIOV
I?Atm WkJDA gm a-V 17 Z`77�0 DATE Z/_ t
ADDRESJ 9% � � 3S8" _
R/►'�A( _C Z'irG 3 LOCATION S11EFF1tc_A Rt'-) 70
LOT SII E 2d7D x Z� / - (..I4't'`` /N
TOPOG PHY: S
SOIL T ��TURE s �
SOIL STRUCTURE:
DEPTH:
RESTRI TIVL H6RIiOFSS
PERCOLATION PATE: Presoak Bark & time I Drop Time Pate/Iiin. Inch
1. — .5-", 9A)`2. /o f OG Z" I P 20
2. 7 /z` r-"Z,
3.
***CLA SIFICATI02?t
Suitable Provisionally Suitable Unsuitable
COiPEl1 Ss
SANITARIAII:' '�""
SITE D AGF.A:'t
3
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