122 Halifax Ln - DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in ompliance with G.S. of North Carolina Chapter 130—Article 13c. r
Permit N
'
umber
Name \. �. .r. DateH..r.t.r.Y
Location
Subdivision Nam Lot No. Sec. or Block No.
Lot Size ' House Mobile Home — '�� Business Speculation
No. Bedrooms No. Baths 1" No. in Family
Garbage Disposal YES ❑ NO ❑r' Specifications for System,
Auto Dish Washe YES 0 NO ❑ '!�'
Auto Wash Mach ne YES Q NO E]
Type Water Sup ly ---
*This permit Voi Jif sewage system described below is not installed within 36 months from date of issue.
R-.
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. Teleph ne Number: 704-634-5985.
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Final Installati n Diagram: �-"�� Systbm Installed by
Certificate of Completion Date
*The signing pf 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 COUNY HEALTH DEPARTIENT
ENVIRONIJENTAL HEALTH SECTION
SOIL/SITE EVALUATIOU
PAPS �� DATE
ADDRESS
LOCATION
LOT SIZ
TOPOGRA IiY: --�
SOIL TE ;TURF:
SOIL STRUCTURE:
DEPTH: �
RESTRICTIVE HORIZOFS: /(-olive
PERCOLATION FATE: _Presoak Hark & time Drop Time Fate/ iin. Inch
1.
3.
LA SIFICATIOP?:
Suitable visionally Suitable Unsuitable
C01101S:
SANITARIAPI
SITE DIAGF�
O