1336 County Line Rd (2) 'A DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in'Compliance with G.S. of North Carolina Chapter 130—Article 13c.
,k , Permit Number
� "72
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Name - _ Date
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: 90
Auto Dish Washer YES [] NO E] f
Auto Wash Machine YES Ep NO 0 ��
Type Water Supply �V� ✓t -- ��,> - �,`rv�' ,,:�,.M �',�•�L��r`�_
*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�11r
*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: 704-6-3-4-5985.
Final Installation Diagram: System Installed by--j R t'�1'► ��� ti"
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Certificate of Completion � Date 0
*The signing of this certificate shall indicate that the system described1above 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 COUFTY HEALTH DEPART IEAIT
ENVIRONMENTAL HEALTH SECTION
SOIL/SITE EVALUATIOP
DATE / ' 2-3 r 92—
ADDRESS-9
2—ADDRESS9 IJ S
'y`�' ✓��. 2 �� LOCATION
LOT SIZE /3
TOPOGRAPHY:
SOIL TE,',TURE: /LTA GL{ t �dh
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SOIL STRUCTURE
DEPTH: .
RESTRICTIVE HORIZONS:
PERCOLATION RATE: Presoak Bark & time Drop Time Rate Yiin. Inch
A`: 3 )
2.
3. ,d :Ys yZ 4
***CLASSIFICATIOIT: �
Suitable Unsuitable
COAP-,IEITTS:
SANITARIAFT �'" "
SITE DIAGFAM
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