128 Norma Lane Lot 30"Note: Issued
Name
Location
V DAVIE COUNTY HEALTH DEPARTMENT Z"
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
;ompliance with G.S. of. North, Carolina Chapter 130—Article 13c. .
is Permit Number
2946
� Date 7 ' Z.•�
Subdivision Name _,
Lot Size
No. Bedrooms_
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type ,Water Supply
04 - Lot No. 33 Sec. or Block No.
House" ,Mobile Home _ Business Speculation
_ No. Baths No. in Family _
YES ❑ NO Specifications for System: ppaTi��r
YES NO ❑
YES •0' NO ❑ j .1/ Z1/llwr
age system described below is not installed within 36 months from date of issue.
i.,
rVI 1A
Improvements permit by -�
.i
'Contact a representative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or 1:0011:30�'P.M. on day of completion. Telephone Number: 704-634-5985.
I,
Final Installation DiagramSystem Installed by, AL'
3
.10
G
l
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11 Certificate of Completion (:_�!s . Date b -Zq
'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 DEPARTIETT
EITVI?OIti I,TTAL HEALTH SECTION ,
SOIL/SITE EVALUATIOI? Laf
DATE
T
ADDRESS ?-
LOCATIOI?y/
LOT SIZE,
TOPOGRAPHY: ?S
SOIL TEaiTURE > S
,r
SOIL STRUCTURE: 5
DEPTH: f
RESTRICTIVE HOPIZOUSo
PERCOLATIOE FATE:
2.
3.
Presoak
Turk & time
Drop
Time
Pate/lin. Inch
Gti ;,4,
-
i
I: J
*** CLAS S IFICAT IOIT s
Suitable Provisionally Suitable Unsuitable
COQ KITTS t -c
SANITARIAIT /yl9tip�
SITE DIAGRAM
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