655 Pineville Rd (2) DAVIE COUNTY. HEALTH DEPARTMENT
JMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issutd'in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
% l
Name Date
Locati
i-
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 ❑ Specifications for System:
Auto Dish Washer YES E] NO ❑ - '.�t .
Auto Wash Machine YES ❑ NO ❑ ✓
Type Water Supply
*This permit Void if sewage system.described below is not installed within 36 months from date of issue.
,t
S
i
Improvements permit by
*Contact a representative of the Davie County H alth Department for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completi n. Telephone Number: 704-634-5985.
Final Installation Diagram: � System Installed by 0�
7l ��
Certificate of Completion Date —
*The signing of this certificate shall indicate that the system des*b � ve 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.
y.r DAVIE COUNTY HEALTH DEPARTMENT
•,--,IJWF?ROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name r, . �. r;, ,r1.__ ._ -- `.Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size %�� � House Mobile Home —i-� Business Speculation
No. Bedrooms ✓ No. Baths No. in Family
Garbage Disposal YES NO Specifications for System: a �,
9 P ❑ ❑
Auto Dish Washer YES ❑ NO ❑ '
Auto Wash Machine YES ❑ NO ❑
Type Water Supply
*This permit Void if sewage system;described below is not installed within 36 months from date of issue.
11 ;
!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.
1
Final Installation Diagram: i System Installed by
px"y
r h
Certificate of Completion �� Date
*The signing of this certificate shall indicate that the system describle�rd 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.
DAVIT COUFTY HEALTH DEPARTiEI?T
, ENVIROMMENTAL HEALTH SECTION
SOIL/SITE EVALUATION
I?AIs A: , nllA nr z) DATE
ADDRESS 6q IZ`I ISI
ybt,ocKSt/t��� IJ L LOCATION Pimulc f 2�.
Sri .
LOT SIZE. 1( Y2 AC.
TOPOGRAPHY: C;o-a P
SOIL TE:.TURE: S&w"
SOIL STRUCTURE:
DEPTH:
RESTRICTIVE HORIZONS:
PERCOLATION PATE: Presoak I•iark & time Drop Time Rate/iiia. Inch
1. to z SS
2. 2;ST ��2 � lS �o
3.
***CLASSIFICATIOIT:
Suitable Provisionally Suitable Unsuitable
COIR IEUTS:
SANITARIAIT
SITE DIAGRAM
Q
------------
x DAVIE COUNTY HEALTH DEPARTMENT
AdENVIRON,14ENTAL HEALTH SECTION
�+ P.O. BOX,57
MOCKSVILLE C.- 27028
" (704) ° 34-5985
STATEMEIZT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAME,;fA .f DATE4 • Z Z �
ADDRESS TZ T, R SY Z PERMIT NO. G 27517j'r Z7rZ,
EXPLANATION OF CHARGE S)7 rr- fyA c IJAV VI— ' Z- IYI Pio n
AMOUNT DUE Q SANITARIAN
PLEASE REMIT THE ABOVE AMOWT OF RECEIPT OF THIS STATEMENT. .
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.
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