228 No Creek Rd `--`t'- DAVIE COUNTY HEALTH DEPARTMENT J
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name ' = Date
Location .- • ";;' ��%' � `�., . ..�";-b%�.• .''; %,:;;r`t'_ �f_". ,,�
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _'—'�^ Business Speculation
No. Bedrooms - No. Baths `2 No. in Family —�
Garbage Disposal YES p NO p'` Specifications for,System:
Auto Dish Washer YES p NO
Auto Wash Machine YES p NO p
Type Water Supply `
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
I
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 by
1 �
1
Certificate of Completion �` �'n^�h° 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 COUi?TY HEALTH DEPART1IEiTT
ENVIRONI.MHTAL HEALTH SECTION
SOIL/SITE EVALUATION
ITAIMMG./.�i��_ DATE
ADDRESS
LOCATION
LOT SIZE p
TOPOGRAPHY:
SOIL TEXTURE
SOIL STRUCTUREPTH z?Z--e7g
yYL
RESTRICTIVE HOP.IZOT?S
PERCOLATION FATE: Presoak Hark & time I Drop Time Rate/ lin. Inch
—
2.
3. f', h�S
***CLASSIF'ICATIOI?:Suitable Provisionally Suitable Unsuitable
C015, ITTS:
SMITARIAN
SITE DIAGFAPi
1
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