2355 Angell Rdi DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chanter 130—Article 13c.
Name, = s
Location
Subdivision Name
Date 1 '
Lot No
Permit Number
2,0) C
Sec. or Block No
Lot Size '
House
Mobile Home _ Business Speculation
No. Bedrooms 3
No. Baths
No. in Family
Garbage Disposal
YES
❑ NO ❑
Specifications for System: c- D- l �,
Auto Dish Washer
YES
❑ NO ❑
, -� . ' y , „ , �� , e -
Auto Wash Machine
YES
❑ NO C]
j
Type Water Supply
I i
_
"This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
41
"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:
rl
0,7i/4 CALL
O'L, L�v �/L
System Installed byi-y)�D
Certificate of CompletionDate" �3 - 92—
'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.
t
DAVIL COUITTY HEALTH DEPAP.TIEidT
EITVIROITHENTAL HEALTH SECTION
SOIL/SITE EVALUATIOIT
ITAT9E ,
DATE
ADDRESS XV4. , - 8 /72.
27o 2S-' LOCATION
,7�Llzl •G F%/1 G ��%• f/lt ���t 4 w rt? �Ar.,�� ,�riz- d�X_ - �l ixl-e�
LOT SIZE
TOPOGRAPHYa S eel
SOIL TE,'iTURE E /r'S 3
SOIL STRUCTURE:,PS
A '� S cI�% _ n/o rri n c ' ��o k 3
DEPTH: 3,. -V -,o
RESTRICTIVE HORIZOITS: y!V- VZ " $ /;s l �,%n �P itco7i�t - so-ti
PERCOLATION RATE:
3 �d AJF1.
Will 3.
Presoak
Hark & tine
Drop
Time
Fate/iiin. Inch
E•n��
�" /o:�s"
�i
/o; f
***CLASSIFICATIOIT s
SuitableProvisionally Suitable Unsuitable
COMIMITTS
SITE DIAGEASAPTITARIAIT
Ni