137 Kosy Trail 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 -n t F_ ! Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home —L—* Business Speculation
No. Bedrooms No. Baths No. in Family 7
Garbage Disposal YES ❑ NO ❑-
Specifications for System:
Auto Dish Washer YES ❑ NO fl'
Auto Wash Machine YES p- NO ❑ ` '
Type Water Supply _
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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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 by1c^
11
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Certificate of Completion �' CIS, Date O
*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.
DAVIT COUM HEALTH DEPAP.T IEITT
EIIVIIO1T11ENTAL HEALTH SECTION
SOIL/SITE EVALUATIOiT
ITAIS �,e«� /�1ev1 C 3,�S�'9G DATE
ADDRESS rlo-Ael 7id'
/yloC,�t�✓/4 �7v�y LOCATIO1.14
:440� oou sA ee rn
LOT SIZE /2 aCceS
TOPOGRAPHY: a 1:S0.. ( ` -
SOIL TE,7TURE: Kms./ t xu C.,a F°=r
SOIL STRUCTURES l - ctz r,x7-4-t- -
DEPTH: .gM-0- no eu,,,O- Y' v, A(e,, N S 4-f r n - A--, d2--rL `� 4
RESTRICTIVE HOPLIZOILS: ro �c e . :.0c
PERCOLATION FATES Presoak Marl: & time I Drop Time Fate/iii%. Inch
� �µ�21. 3.1 nc� '2 -
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3. Z
***CLASSIF'ICATIOIT°
' ; Provisionally Suitable Unsuitable
COMIEUTS:
SAIIITARIAIT Q!, YVLC -,c�e
SITE DIAGFAY1
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