586 Main Church Rd (3) D"/IE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
�l Permit Number
Namer_ i Date //'/ '.r.�f" , ' ' '
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 0 Specifications for:System:
Auto Dish Washer YES E] NO ❑ ,'-
Auto Wash Machine YES p NO ❑ �' ��� ,;
Type Water Supply .,t_�j __ J/,1
*This permit Void if sewage system described below is not installed within 36 months from'date sof issue.
SS�
1�
Improvements permit 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 completion. Telephone Number: 704-634-5985. ,, jj
Final Installation Diagram: I rr1 System Installed by �5�f.(L �tti1L. WIj{ZQ
J Certificate of Completion Date
it
*The signing of this certificate shall indicate that the system described above has been installed in compliance with
the standards seffo`�in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily for,any giv' period of time.
DAVIE COUITTY HEALTH DEPARTIENT
ENVIRONI-(ENTAL HEALTH SECTION
SOIL/SITE EVALUATIOU
ITA14E (7� �'` /" ", DATE���L�' `
ADDRESS
LOCATIOIN
LOT SIZE
TOPOGRAPHY.
SOIL TEhTURE:l;?S,
SOIL STRUCTURE: ,'' ,
DEPTH. %►-J ��
RESTRICTIVE HORIZOUS:
PERCOLATION PATE: Presoak Bark & time I Drop Time Rate/!!in. Inch
2.
3.
***CLASSIFICATIOIT: ,
Suitable P(:: rovisionally Suitable nsuitable
COIIEITTS:
SANITARIAIT
SITE DIAGRAM
G'
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