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P3519 Granada Drivei. ^ �~ DA�E COUNTY �� ����������� � ] �"��""" \l �—` - ' IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION ' v °NOTE: |oouod in Compliance with G.S. of North Carolina Chapter 130 Article 13o Sewage Treatment d Disposal Rules (10 NCAC 10A .1934-.1968) Permit Number Name Date Location D4 IQ, Subdivision Name. Lot No. Sec. or Block No. ^~ Lot Size House Mobile Home -- Business —.__—_—_ Speculation -----__—_ No.Bodroomo No. Baths No. inFamily —_—_____' Garbage Disposal YES O NO 1/ Specifications for System: Auto Dish Washer YES NO [� Auto Wash Machine YES Type Water Supply *This permit Void if sewage system described below is not installed within 36 months from date of issue. /�c..X , /~/ ' \ � / � � \ / \ ` / / Improvements permit bv °Contaota representative of the Dave County Health Department for final inspection of this oyabam between 8:30' 9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985. Final |nobu|aUon'D� 'ram: 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 vegu|sdion, but shall in NO way be taken as aguarantee that the system will function satisfactorily for any given period of time. APPLICATION FOR SITE EVALUATION/ IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section P. 0. Box 665 Mocksville, N.C. 27028 CONSTRUCTION SHALL NOT BEGIN UNTIL IMPROVEMENTS PERMIT HAS BEEN ISSUED. Home Ph nA fu — 1. Permit Requested By i� _A, Business Phone -!W'o 2. Address Jge,- 40 Q Iva 3. Property Owner if Different than Above Address 4. Permit To: a) Install-ZAlter Repair b) Privy— Conventional— Other Type— Ground Absorption c) Sub -Division ec - Lot No — ' 5. System used to serve what type facility: House Mobile Home-AMusiness b) Number of people I Industry— Other 6. a) If house or mobile home, state size of home and number of rooms. House Dimensions— Bed Rooms 'I Bath Rooms Den w/Close b) If Business, Industry or Other, State: Number of persons served What type business, etc. Estimate amount of waste daily (24 hours) 7. Number and type of water -using fixtures: commodes urinals garbage disposal lavatory. showers washing machine �dishwasher sinks 8. a) Type water supply: Public— Private— C 'munity__ZZ b) Has the water supply system been approved? Yes_(,7No_ 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? What type? This is to certify that the information is correct to the best of my knowledge. Date ZZ4ajI— )2 Owner Signature OWNER IS SOLELY RESPONSIBLE FOR COMPLIANCE WITH ALL STATE AND LOCAL LAWS Allow 5 days for processing Directions to property: 'V C- -15�_74 7o Co&WA/t"7z:el� /�,/, Ta � tu Ze 0-i /7 JJ 0 C K C Ta A _5_t7l&� Alfll 2 O/V zj/ qel "To 4, -5-e IC 0 IV dA) _V C DCHD (6-82) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section R 0. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION Name Date Address Lot Size 1:Ar.Tr)P.Q APPA 1 A PPA 9 ARFA.1 ARPA A 1) Topography/ Landscape Position (i�> S S S PS PS PS ILI U U U Soil TextLfre (12-36 in.) Sandy, S S S Loamy, (note 2:1 Clay) PS PS PS U U U U Soil Structure (12-:36 in.) S S S Clayey Soils, PS PS PS U. U U 1) Soil Depth (inches) S S Ps PS PS U U U U i) Soil Drainage: Internal S S S. PS PS -PS U U U U External S S S PS PS PS PS U U U U Restrictive Horizons Available Space S. S S PS PS PS PS U U U U 1) Other (Specify) S S S PS PS PS :'PS U U U U 1) Site Classification IM U—UNSUITABLE S—SUITABLE PS—Provisionally Suitable Recommendations/Comments: Described by SITE DIAGRAM DCHD (6-82) - f