525 Chinquapin Rd c:
DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
j Permit Number
Name `4'-% t,,,..1 r t�1 Date 1-+ 2 t; ' G t .ti
Location f.,;>t t.t €,; �' I t t t.f ..f r'. r r.i p j i �} r;.'•r!r ti 0 �t r c ; j,•;.� �..
Subdivision Name _ Lot No. Sec. or Block No.
Lot Size House Mobile Home _""✓ Business Speculation
No. Bedrooms No. Baths No. in Family �w
Garbage Disposal YES ❑ NO p" Specifications for System: 000
Auto Dish Washer YES ® NO ❑
Auto Wash Machine YES [t] NO F-1
Type Water Supply
"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: System Installed b Lf-v
c
� l;✓ ��
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 COUNTY HEALTH DEPARTIMTT
ENVIRONI,'ENTAL HEALTH SECTION
SOIL/SITE EVALUATIOP
PAIS .J ZSiy�z . � ,��L� DATE 1
ADDRESS
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LOT
TOPOGRAPHY: S
SOIL TE,',TURE:
SOIL STRUCTU E :
DEPTH:
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RESTRICTIVE HGP�IZOITS: in
PERCOLATION RATE: Presoak Bark & time 1. Drop_ Time Pate iin. Inch
2.
3. (/VEL.. (a - 28YA, d
***CLASSIF'ICATIOIT: i-
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Suitable Provisionally Suitable � Unsuitable
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