P2949 Dick VoglerDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Name -` / /= Date _
Location
Permit Number
Subdivision Name Lot No. Sec. or Block No.
Lot Size
No. Bedrooms
Garbage Disposal
Auto Dish Washer
Auto Wash Machine
Type Water Supply
House Mobile Home—'----*--' Business Speculation
_ No. Baths No. in Family
YES p NO E] . Specifications for System:
YES E NO p
YES Q NO p
i;
r
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
r
1
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: 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 for any given period of time.
1(
1
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: 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 for any given period of time.
DAVIE COUI?TY HEALTH DEPAPM EMIT
EP?VIRON1,1ENTAL HEALTH SECTION
SOIL/SITE EVALUATIOIT
ITAIM
ADDRESS
LOT SIZE:
TOPOGRAPHY: S
SOIL TMI.TURE :
�^ yip
SOIL STRUCLURE:�� , 0? SCJ
DEPTH:yG Zt,
RESTRICTIVE HORIiOFS: '97ly "
PERCOLATION FATE:
1.
2.
3.
DATE
LOCAT I014
Presoak
Idark & time I
Drop
Time
Pate/iiin. Inch
%*CLASSIF'ICATIOP?:Suitable royisionallySuitable Unsuitable
COMIEUTS :
SAT?ITARIA11
SITE DIAGFAY1
6
0
0