135 Castle Ln • 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 /f' Date
Location
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 p NO E] Specifications for.System:
Auto Dish Washer YES p NO i]
Auto Wash Machine YES r-il NO
Type Water Supply _—
*This permit Void if sewage system described below-isnot-instal led-with in-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: n , 'System Installed by
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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 COUP?TY HEALTH DEPART IENT
ENVIR0111,214TAL HEALTH SECTION
SOIL/SITE EVALUATIOU
VAME�f�U.' �'/1.6� DATE ZD
ADDRESS
LOCATIO11
LOT SIZE
3
TOPOGRAPHY: S
SOIL TE2'TURE:/ • Jr
SOIL STRUCTURE: • �
DEPTH: '� •�
RESTRICTIVE HORIZOUS:
PERCOLATION PATE: Presoak Hark & time Drop Time Pate/ lin. Inch
2. - .
3.
**CLASSIFICATIOP?:Suitable„_.._ Provisionally Suitable--""Unsuitable
COMIEUTS:
SANITARIAN �
SITE DIAGP"
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