2068 Liberty Church Rd 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 { f✓ — Date
_
Location , ,f�; . l�;E" . ! C
r"
,
Subdivision Name Lot No. Sec. or Block No.
Lot Size ' �` �;L House '"` Mobile Home — Business Speculation
No. Bedrooms 'No. Baths` No. in Family
Garbage Disposal YES NO
g p E] Specifications for System:
Auto Dish Washer YES [] NO 0 ", _ U
Auto Wash Machine YES NO 0
Type Water Supply (:.1 t- C, -- �i - i,.5 L >4
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
/i
r �
f�
l
Improvemen0permit by -
*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 compJ'etion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by ''�s��t
ivCertificate of Completion Y ='f Date - - /D
qQlbof this certificate shall indicate that the system desc bled above has been installed in compliance with
.t forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
any given period of time.
DAVI COMITY HEALTH DEPART 0-17T
ENVIR0111-214TAL HEALTH SECTION
SOIL/SITE EVALUATIOU
rAmE 6 f-`-Al DATE
ADDRESS fZ (
GIGS (/jc L / c LOCATI014 bet-"LT-1 �if' 1. A1.9
LOT SIZE
TOPOGRAPHY:
SOIL TMITURE: CtAtj
J
SOIL STRUCTURE: &V
DEPTH:
�6
RESTRICTIVE HORIZOES:
PERCOLATION RATE: Presoak Bark & time grop Time Pate iiin. Inch
1. 7)9'`'7 -g� S • Zj W 2D
2.
3.
%*CLASSIFICATIOP?:Suitable Provisionally Suitable Unsuitable
COM-1E1TTS:
SANITARIAPT �_--�-
SITE DIACF,AM
d,.� f