1425 Milling Rd (3) 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 Date
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 ❑ Specifications for System:
Auto Dish Washer YES•❑ NO ❑,_.
Auto Wash Machine YES ❑ _NO ❑
Type Water Supply _—
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
i .
F
i
. i
Improvements permit by —
*Contact a representative of the Davie County Health Department for final inspection of this system between 8:307
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
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 systemwill function
satisfactorily for any given period of time.
i
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 Date t ®�
Location r
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 E]_-----
Auto Dish Washer {`' YES E:] NO 0--- Specifications for System:
Auto Wash Machine YES NO
Type Water Supply _
YP
c +
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
f
Sk
Improvements permit by
i
*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'comion'T phorie Number: 704-634-5985.
Final Installation Diagram: i� System Installed by
w
• e
Certificate of Completion Date r�
*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.
'I
r
DAVIT COUPTY HEALTH DEPART_IEITT
ENVIZOtTi-MUTAL HEALTH SECTION
• SOIL/SITE EVALUATIOU
IIA14E
Aa,45 DATE
ADDRESS ��9
LOCATIO:T
Xe
w/
LOT SIZ!,-
TOPOGRAPHY:
SOIL TEhTUREs
SOIL STRUCTURES ,
DEPTHS
RESTRICTIVE HORIZOITS S Ale"V e
PERCOLATION PATES Presoak Bark & time Drop- Time Pate/11i%. Inch
2. - ,, 1
3•
** CLASSIFICATIOITSSuitable Provisionally Suitable Unsuitable
COMMITTS S
SANTTARIAFT
SITE DIAGRAM
i1 DAVIE COUNTY HEALTH DEPARTMENT
10 IRONMEITTAL HEALTH SECTION
• i ! 'w - ,
P.O. SOX 57
MOCKSVILLE. N.C. 27028
(704) 634-5985
STATE2I1T FOR SEPT TAPdK IMPROVEMEidTS PER��IITS AND/OR'SITE-EVALUATIONS
NAME r _. DATE___fes' J
ADDRESS °t PERMIT NO.
i
c
EXPLANATION OF CHARGE
AMOUNT DUE � SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
I^rorovements Permit(s) can not be issued until payment is received.