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691 Richie Rd (2)- 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
Subdivision Name
Lot No
Sec. or Block No
Lot Size _��f
House
�-'
Mobile Home — Business Speculation
No. Bedrooms
-
No. Baths
No. in Family
Garbage Disposal YES p NO 21-11 Specifications jor System:
Auto Dish Washer YES 5 NO ,Q
Auto Wash Machine YES 0 NO 0 ;',�k- 1 j VY
Type Water Supply _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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:
�-Sgstem Installed by/
W A1 - r�
C
' ��fliw!/
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 ! e taken as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUP?TY HEALTH DEPART IEITT
ENVI?RONHENTAL HEALTH SECTION
SOIL/SITE EVALUATIOI?
or
DATE
ADDRESS
LOT SIZE
TOPOGRAPHY:
SOIL TE:,TURE:
SOIL STRUCTURE ems` • f
DEPTH:
RESTRICTIVE HORIZONS:
PERCOLATIOPI PATE:
1.
2.
3.
LOCATIO'sd
Presoak
Mark & time
D op
Time
Rate/iiin. Inch
***CLASSIFLCATIOI?:
Suitable Provisionally Suitable Unsuitable
COIP-:3EIITS:
SAA?ITARIAIT
SITE DIAGF-4.M
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