4985 Hwy 158 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 / Zelt a `
Location XOg�LZ2�
1//W_ /v Inx
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business _Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO �aX
Auto Dish Washer YES E] NO
Specifications for System:
Auto Wash Machine VrQ ❑ NO god X�or
Type Water Supply ___ /D0/Ir_5
`This permit Void if sewage system described Belo Iled within 36 months from date of issue.
r
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 byl'' L Td l�
I '
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 COU'eTY HEALTH DEPARTIENT
ETIVIROBi.20TAL HEALTH SECTION
SOIL/SITE EVALUATIOF
VAIE DATE /"� I'leKh"I
ADDRESS
LOCATION
LOT SIZE
TOPOGRAPHY:
SOIL TE:1TURE:
SOIL STRUCTURE:
DEPTH:
RESTRICTIVE HORIZOFS:
PERCOLATION RATE: Presoak Hark & time Drop Time Rate iiin. Inch
2.
***CLASSIFICATIOP?:
S 1table Provisionally Suitable Unsuitable
COMIMIT S:
SAID?ITARIAN
SITE DIAGF,AM
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