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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 0 ©� D l