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DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Name
Location
Date
Permit Number
Subdivision Name ` ^' ` — `` j I Lot No. Sec. or Block No.
Lot Size / , 2-t l House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
YES p NO
YES NO fl
YES ❑ NO []
Specifications for System: % CSU J <
Ft 1 i1
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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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:
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System Installed by
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 be taken as -a -guarantee that the system will function-
satisfactorily
unction satisfactorily for any given period of time. -
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DAVI3 COUFTY HEALTH DEPART IENT
ENVIiSOITI.fENTAL HEALTH SECTION
SOIL/SITE EVALUATIOF
DATE G - Z ( -- '� Z
ADDRESS 3SD Ft SHE t- R 0 C a� S � & (, -,T/ $.v
791/- 6FI3
C,-) - 71oi LOCATION L14
LOT SIZE
TOPOGRAPHY:�
SOIL TEZTURE s
SOIL STRUCTURE: &V /�� • ��:���
DEPTH: V? -
RESTRICT IVE,
?-RESTRICTIVE HORIZOI?S a
PERCOLATION FATE:
1.
2.
3.
Presoak Bark & time Drop Time Fate iiin. Inch
***CLASSIFICATIOI?:Suitable Provisionally Suita Unsuitable
C011HEITTS s
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SANITARIAIT
SITE DIAGFAI
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