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P5825 Will Boone Rd DAVIE COUNTY HEALTH DEPARTMENT IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION *NOTE:Issued in Compliance With Article I I of G.S.Chapter 130a -Sanitary Sewage Systems S V. Permit Number Name �, r/ � i,/ `.��- /�,�,�✓ Vii'/ , .2y �'p�e �,1sAV" N2 5825 Location 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 a Specifications for System: Auto Dish Washer YES NO ❑ Auto Wash Machine YES NO ❑ `���` Type Water Supply *This permit Void if sewage. st, \dcribed below is not installed within 5 years from date of issue. This permit is subject to revo ati if Site plans or the intended use change. 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 by t 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. APPLICATION FOR SITE EVALUATION/IMPROVEMENTS PERMIT Davie County Health Department Environmental Health Section 1 , P. 0. Box 665 J Mocksville, NC 27028 RECE'VED JAN 18 1990 1 . Application/Permit Requested By Mailing Address ILI �0 �b� c�3© MSC_ SU0-'�i� Home Phone 1D -kctoa. Business Phone �3U- Sal 2. Name on Permit if Different than Above 3. Property Owner if Different than Above 4. Application/Permit For: 0 General Evaluation s/Tank Installation 5. System to Serve: (] House 81"Mo bile Home 0 Business 0 Industry 0 Other 0 Unknown 6. If house, mobile home: Subdivision Sec. Lot# No. of People Dwelling Dimensions No. of Bedrooms66� Basement/Plumbing No. of Bathrooms Basement/No Plumbing lashing Machine J Dishwasher 0 Garbage D:isposai 7. If business, industry, other: Specify type No. of People Served No. of Sinks No. of Commodes No. of Urinals No. of Lavatories No. of Water Coolers No. of Showers 8. Type of water supply: eublic 0 Private 0 Community 9. Property Dimensions 10 Sewage Disposal Contractor 11 . Do you anticipate additions/exp nsions of the facility this system is intended to serve? 0 Yes X70 If yes, what type? *NOTE: Improvements Permits shall be valid for a period of 5 years from date issued. Improvements Permits are subject to revocation, if site plans or the intended use change. Effective October 1, 1989. This is to certify that the information provided is correct to trig best of my knowledge, and I understand I am responsible for all charges incurred from this apple atian. Is qP Date h + Signature alxx-� 22i(Jhnn t 12d. (nnrazna n�E Der3mona as 2A mIps Directions to Property : J on 1p� Fn Vf w 4- Cn.� c., aA-uca DCHD (10-89) DAVIE COUNTY HEALTH DEPARTMENT Environmental Health Section. P. O. Box 665 Mocksville, N.C. 27028 SOIL/SITE EVALUATION / Name %��� Date Address Lot Sizee FACTORS AREA 1 AREA 2 AREA 3 AREA 4 1) Topography/Landscape Position Q CS PS PS PS PS U U U U 2) Soil Texture (12-36 in.) Sandy, S --� `S Loamy, Clayey, (note 2:1 Clay) `Q 3) Soil Structure (12-36 in.) S Clayey Soils AU 4) Soil Depth (inches) S PS U ��jj 5) Soil Drainage: Internal S PS (b &> U U U External � U S _- S -< 6) Restrictive Horizons 7) Available Space c S PS PS PS U U U U 8) Other (Specify) S S S S PS PS PS PS U nnU U U 9) Site Classification r`l y� U—UNSUITABLE S—SUITABLE PS Provisi ally Suitable Recommendations/Comments: Described by Title S7�'Y� Date W SITE DIAGRAM DCHD(6-82)