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242 Dogwood Lane Lot 77-82�.� 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 Location 1e�u..rllL Qf T Isg - qac art of s -I• –t' �e�-1- --T. 2-� Subdivision Name w.w��ah �! Lot No.77, 7Y 90, � RSA or Block No. Lot Size House ✓ Mobile Home — Business Speculation No. Bedrooms 3 No. Baths 2 No. in Family .3 Garbage Disposal YES ©^ NO ❑ Specifications for System: 1��9 �►r_'� S' Auto Dish Washer YES p' NO ❑ i; x, ��, Auto Wash Machine.: YES [' NO ❑ + Type Water Y Su I PP *This permit Void if sewage system described below is I;not installed within 36 months from date of issue. i! l� *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: `i System Installed by j AA �i. Certificate of Completion %\A� C�,�� Date *The signing of this certificate shall indicate that the system describe 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 f satisfactorily for any given period of time. ;! �►; 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 (A 2 L _D • ;c_l &� Date Location Subdivision Name `"'' Lot No. 7-/- Sec"or Block No. Lot Size ^ "' ` °' `' `' _ House Mobile Home — Business _— Speculation No. Bedrooms No. Baths No. in Family Garbage Disposal YES E_ NO ❑ Specifications for System: 12.50 V9j'%-' S T 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 \l *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 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 C�2 r�. t�y:cC�,� 2- Name � Date Address �' `�• g �Lot Size -3-6-6 x 060 /noG,C 2 70 2,r 14 K CAflrnDO ARCA 1 ARFA 9 ARFA R ARFA 4 Topography/ Landscape Position PS PS PS PS U U U U !) Soil Texture (12-36 in.) Sandy, oam layey, (note 2:1 Clay) PS S Com'' S � PS U U U 1) Soil Structure (12-36 in.) Clayey Soils S ® S LE -S--) Ebb S U U U U Soil Depth (inches) Q PS PS PS PS U U U U i) Soil Drainage: Internal ® S / ` U U U U External PS PS PS PS U U U U i) Restrictive Horizons ') Available Space S PS S PS PS U U U U I) Other (Specify) S PS S PS S PS S PS U U U U ;) Site Classification � -I- S U—UNSUITABLE Recommendations/Comments: S—SUITABLE PS—Provisionally Suitable ?na & . � Described by Title �.:�kaAJA Date 2-11-p3 SITE DIAGRAM DCHD (6-82) 4 i 10 2 APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department' Environmental Health Section Qf R O. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Phone 13 � • — - 3 // 1. Permit Requested By04` v- Business Phone I,, 3 �t —23'7 / 2. Address d 3. Property Owner if Different than Above Address 4. Permit To: a) Install Alter Repair c �/i` b) Privy Conventional�Other Type G "� a ra f^� 'L �'`��• Ground Absorption /7 c) Sub -Division P" Ono r1 /a^N_4ec. Lot No. � 8 5. System used to serve what type facility: Housed Mobile Home Business IndustryOther b) Number of people 5 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions (50' X A Bed Rooms— Bath Rooms— Den w/Closet b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes Z urinals lavatory 2 showers dishwasher 1 sinks I 8. a) Type water supply: Public_ Private Community b) Has the water supply system been approved? Yes-ZNo &Z),G 9. a) Property Dimensions �l�t�V_ b) Land area designated to building site c) Sewage Disposal Contractor ��(, P c 1. t 10. Do you anticipate any additions or expansions of the facility this sewage sy6 What type? garbage disposal washing machine S yS� y,1 is intended to serve? This is to certify that the information is correct to the be of my knowle '2-- - d 3 Date Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: �d Wbcs ��7�-X79-�a—`E(—g2�' � 0 -r-c- : C t9 V -,4j V. V r O -Z- f,t ad �S V__ w % / ( � G.., DCHD (6-82) 04 rI� Lm �kwS..