318 Granada Drive Lot 1-AAPPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT pQ,
\ Davie County Health Department 0�
Environmental Health Section Gly*
P. O. Box 665'i
Mocksville, N.C. 27028
CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED.
// Home Chone>9g $ "3 6 8
1. Permit Requested By 64c–=`–' `(n��� '�'R- Business Phone
2. Address /%7,,c_&Y,////G N(. a"7(%,-7.
3. Property Ow
Address —
4. Permit To: a) Instal
b) Privy
Conventional Other Type
Ground Absorption
c) Sub -Division Sec. Lot No.
5. System used to serve what type facility: House Mobile Homed Business
IndustryOther
b) Number of people 2
6. a) If house or mobile home, state size of home and number of rooms.
House Dimensions -5 `l Imo' l y ,,
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) fDwi✓s
7. Number and type of water -using fixtures:
commodes urinals garbage disposal
lavatory showers f washing machine Z
dishwasher sinks 6
8. a) Type water supply: Public Private Community
b) Has the water supply system been approved? Yes No
9. a) Property Dimensions
b) Land area designated to building site
c) Sewage Disposal Contractor
10. Do you anticipate any additions or expansions of the facility this sewage system is intended to serve? NONE
What type?
This is to certify that the information is correct to the best of my knowledge.
Date Owner Signature
OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS
Allow 5 days for processing 1& 4 . 7
Directions to property:
.16
IV
DCHD (6-82)
V/
w
DAVIE COUNTY HEALTH DEPARTMENT
f Environmental Health Section
P. O. Box 665
Mocksville, N.C. 27028
SOIL/SITE EVALUATION
Name
Date
S
S
Address
Lot Size
',2
PS
FACTORR ARFA 1 ARFA 9 ARFA.1 ARFA d
Topography/ Landscape Position
SS
S
S
PS
PS
PS
U
U
U
Soil Texture (12-36 in.) Sandy,
S
S
S
Loamy, Clayey, (note 2:1 Clay)
PS
PS
PS
U
U
U
U
u3) Soil Structure (12-36 in.)
S
S
S
Clayey Soils
PS
PS
PS
PS
U
U
U
4) Soil Depth (inches)(%
S
S
S
PS
PS
PS
U
U
U
Soil Drainage: Internal
S
S
S
pS
PS
PS
PS
U
U
U
External
S
S
S
PS
PS
PS
U
U
U
6) Restrictive Horizons
7) Available Space
S
S
S
PS
PS
PS
PS
U
U
U
U
8) Other (Specify)
S
S
S
S
PS
PS
PS
PS
U
U
U
U
9) Site Classification
U—UNSUITABLE
Recommendations/ Comments:
Described by _
SITE DIAGRAM
O
OCHD (6-62)
S—SUITABLE ., 1 —Provisionally Suitable
/ Titler� 2 Date
T STATEMENT
DAVIE COUNTY HEALTH DEPARTMENT
' • ENVIRONMENTAL HEALTH SECTION
210 HOSPITAL STREET
P. O. BOX 665
MOCKSVILLE, NORTH CAROLINA 27028
(704) 634-5985
DATE 3-26-87
Ellie Johnson
2312 Granda Dr.
Advance, NC 27006
Site Eval. & Permit 46&7 – X40.00
L I
DETACH AND MAIL WITH YOUR CHECK. YOUR CANCELLED CHECK IS YOUR RECEIPT.
3-26-87
Site F.vnl & Po rmi r 146R.7
x'110 on
it
Q � 1
4"
BALANCE DUE —
:;40.00