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134 Mullins Rd 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 E] NO ❑ Type Water Supply _ f *This permit Void if sewage system described below is not installed within 36 months from date of issue. ; f l --J 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. Final Installation Diagram: System Installed by. f ' Certificate of Completion o r ' 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 system will function satisfactorily for any given period of time. it • DAVIE COUFTY HEALTH DEPART IEI%TT ENVIRONMENTAL HEALTH SECTION SOIL/SITE EVALUATION I?AIM _ /j',�c 1� DATE ADDRESS LOCATION LOT SIZE TOPOGRAPHY: 5 SOIL TEiiTURE: t : SOIL STRUCiUREV), DEPTH: RESTRICTIVE, HORIZOP?S: PERCOLATIOPI FATE: Presoak Mark & time Drop Time Rate/iii%. Inch 2. —'I%D0 3. w- 41.' i ***CLASSIFICATIOII: SuitableProvisionally Suitable Unsuitable COMMIITS SANITARIAN SITE DIAGFAY1 � D G 1 r STATEMENT DAME COMM HEALTH=:DEPARR TENT HOSPITTALSTREET' - P. O. BOX 665. MOCKSVILLE, NORTH CAROLINA 27028 f (M) :1885 DATE oG,as�/ �2- ,ili, �y DETACH AND MAIL WITH YOUR CHECK. YOUR CANCELLED CHECK IS YOUR RECEIPT. op Ods'" 1;i� 1010 r 3 rfv w f FORM F082 Available from GRAYARC CO.,INC.,Brooklyn,NY 11232