4016 Hwy 601S (2) 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 '�` Date
Location ,
Subdivision Nam Lot No. Sec. or Block No.
Lot Size % ' House Mobile Home _ i�!J Business Speculation
No. Bedrooms _ ? No. Baths No. in Family
Garbage Dispos I YES ❑ NO p
Specifications.for:System: ,�• /. '��,
Auto Dish Wash r YES ❑ NO p i" - I ; /
Auto Wash Mact ine YES []--NO ❑
Type Water Sur ply _—
"This permit Void if sewage system described below is not installed within 36 months from date of issue.
1
I
Improvements permit by
*Contact a rep esentative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or :00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
v
2
1
/ u
Certificate of Completion Date
*Thesigning f this certificate shall indicate that the system described'above has been installed in compliance with
the standard set forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily or any given period of time.
DAVIT COUITTY HEALTH DEPART MIT
ENVIRON1,04TAL HEALTH SECTION
SOIL/SITE EVALUATIOP
ITAME `e DATE
ADDRESS
LOCATION
LOT SIZF,
TOPOG
SOIL T :TUREe
SOIL S RUCyURE a
�eel
DEPTH:
RESTRI TIVE HORIZOFS a
PERCOL TI0P1 PATE: Presoak Hark & time Drop Time Rate Tin. Inch
1.
2.
3.
***CLA SIFICATIOIT s
Suitable Provisionally Suitable Unsuitable
CO1111.1 T S:
ISANITARIAIT AW/ 4
SITE T�IACEA,Ni