1422 Godbey Rd j
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 l t<<,/�t, l Z i C,.,�N `i` Date r� �� 2— p C
Location
Subdivision Nam6 Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No. Bedrooms =' No. Baths r' r No. in Family
Garbage Dispos I YES :❑ NO ❑ Specifications for System:
Auto Dish Wash r YES ❑ NO F❑
Auto Wash Mac ine YES ❑ NO -❑ �U '� -� 'y 7 / "f o a Z.oa
J) /-`•v:j' o iv
Type Water Su ply
`This permit Void if sewage system described below is not installed within 36 months from date of issue.
pj;:,-1s2 CALL /r
Improvements permit by
*Contact a re resentative 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: 704-66344-5985.
Final Installation Diagram: System Installed byt?`� c ' -'f1��l�
it
--------------
Certificate of Completion i `lyy- Date r Z
�i
*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
satisfactoril I for any given period of time.
` 1
DAVIv COUPTY HEALTH DEPARTIMIT
ENVII101,71- 4TAL HEALTH SECTION
SOIL/SITE. EVALUATIOU
PAPM 0pj�f 1 DATE �' l�y ' F 2-
ADDRESSI
ILOCATION JAJ 7-Z
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LOT SIZ� �d-D Ac 'em Cc fox L
TOPOGRAPHY: cScr `��L�w `n o s-�z�.✓G--
SOIL T ZTURE: (,&At j 2�"-L �-
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SOIL S RUCTURE: /17jb-'
DEPTH:
RESTRICTIVE HORIZOVS:
PERCOL TION FATE: Presoak Hark & time Drop Time Fate Iain. Inch
2. 6.D/ /t /ZO Clv
3.
*f,.,,CLA SIFICATIOIT:
Suitable Unsuitable
CO D 1EITTS:
• SAP?ITARIAIT
.SITE JI'AGrAYI .
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