165 Brangus Way 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 �''Plt,ri I< . ,�,•.,.i / ` r, �: v�. f }1
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home — Business Speculation
No. Bedrooms No. Baths No. in Family t►i�;l:r�ai>� ��, �_ lJi7�tJ l =,z,rl+�`t�E
-,E] NO ❑
Specifications for System:
Garbage Disposal YES
Auto Dish Washer YES ❑ NO ❑ .1
Auto Wash Machine YES F-1N0 C] � -� X /Z I tSc
Type Water Supply 0-t..j
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
V3,) (YNO -llfgt3 1201
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Improvements,permit by
r
*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.
.- �oAq✓� Co,2�vATI �
Final Installation Diagram: System InstallLN
ed by
�j
Certificate of Completion l' ,��t�_ Date
'The signing of this certificate shall indicate that the system describ9d 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.
DAME COUNTY HEALTH DEPART 1EITT
ENVIRONI-MUTAL HEALTH SECTION
SOIL/SITE EVALUATIOY
IIA14E/P141Gc rP SMUe-/A11-r DATE 3- 7—
ADDRESS
ADDRESS GJklp— 0- !til/LL F �
LOCATION
LOT SIZE
TOPOGRAPHY: S
SOIL TEZTURE: S ,•v'? (_yr��.�
SOIL STRUCTURE:
DEPTH: 3 '
RESTRICTIVE HORIZONS: 5/Sn(ZI-Et v <i
PERCOLATION RATE: Presoah Karl: & time Drop Time Rate/ fin. Inch
2.
3. ray `�V�i.. (6 :G.� Y �t /�P�+� ( 60
"CLASSIFICATIOIt:Suitabl Provisionally Su bl Unsuitable
SANITARIAF?
SITE DIAGRAPt
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