1201 Wagner Rd (2) X,
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 . -� ;� f , , f' .CVs Date
Locatior5 r ! r 4 r' JZ17
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Subdivision Name Lot No. Sec. or Block No.
Lot Size / f o House ?' Mobile Home _ Business __ Speculation
I
No. Bedrooms No. Baths ^� No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:� jx���/
Auto Dish Washer YES ❑ NO ❑
Auto Wash Machine YES E] NO ❑ l/ i� (Vv ,f, `�J
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.
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Final Installation Diagram: System Installed by
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Certificate of Completion 4Date
*The signing of this certificate shall indicate that the system descrit ed 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..
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DAVIE COUiTTY HEALTH DEPARTLIEVIT
EITVIR01,71.04TAL HEALTH SECTION
SOIL/SITE EVALUATIOU
DATE
ADDRESS
i�W e� /Z moi' G
LCCATIOid
LOT SIZE ^
TOPOGRAPHY: 5
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SOIL TE,tTURE:
azme
SOIL STRUCTURE
DEPTH:
RESTRICTIVE HORIZOFS:
PERCOLATION PATE: Presoak Mark & time Drop Time Pate ilia. Inch
2.
3.
***CLASSIFICATIOt able ProvisionallySuitab' Unsuitable
COT LENTS:
SARITARIAIT
SITE DIAGFAM
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