367-377 Seaford Rd ' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note:,Issued in Compliance with G.S. of North Carolina Chapter 130—Article-f3c:
Permit, Number
�� f �' Date, r, 28 .0
Name � -- �P ii. � ��/i i,�S�!`'d�� / f;�.
r
Location !� %�:' r / ��,�� :,f�� „ � /sir f.>/1�1 �.
11/x
Subdivision Name Je Lot No. Sec. or Block Na
... / 'u r, II� f
Lot Size >- House Mobile Home _ Business Speculation
No. Bedrooms No. Baths No. in Family F
Garbage Disposal- YES 0 NO .p!' Specifications.`for System:
Auto Dish Washer' YES , NO p
Auto Wash Machine YES El' NO ❑
Type Water Supply � 1
*This permit Void if sewage system described below`is not installed within 36 months from date of.issue.
4',1w
Improvements permit by U' F'
*Contact a' representative of the Davie County Health Department for final inspection of this system between 8:30-
A.M. or 1:00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by %/-A,
91 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 COMITY HEALTH DEPART:1ENT
ENVIROU1.214TAL HEALTH SECTION
SOIL/SITE, EVALUATIOI!
VAIME DATE �J IF
ADDRESS
LOCATION
LOT SIZE
TOPOGRAPHY:
SOIL TMITURE: 7 '
SOIL STRUCTURE: 7
DEPTH:
RESTRICTIVE HORIZOES:
PERCOLATION PATE: Presoak Hark & time Drop Time Rate/!!in. Inch
2.CLAS SIF ICATIOP?:
SuitableProvisionally Suitable Unsuitable
COMMENTS:
SANITARIAN
SITE DIAGRAM