1136 Cornatzer Rd (3) 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 �J 1 t 111 �1� ('A U 6 t L L - Date � - ��= � 2 7
Location Gana tl.r�. `��,:��� .,�; Cwt C--CAI Nr, 1 i;:
17 'ir jy' i. ZN,
Subdivision Name Lot No. Sec. or Block No.
1
Lot Size 7 House Mobile Home Business Speculation
No. Bedrooms Z No. Baths Z No. in Family S
Garbage Disposal YES ❑ NO
Specifications for System: '-duo
Auto Dish Washer YES ❑ NO C❑
Auto Wash Machine YES ❑ NO ❑ 2 G J, h I? I-�►�<<
Type Water Supply Wc�- _ ►� U,-- C-uY,c2-,--1-L
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
�2\JLL
\ ,
Improvements permit by�l�Z j�
*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�AAVTW I C- Tti�
I� L
2 �
� 2
Certificate of Completion Date / '&Z7—
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
satisfactorily for,any given period of time.
DAVIE COUFTY HEALTH DEPART TENT
ENVIRONI-XVITAL HEALTH SECTION
SOIL/SITE EVALUATIO11
VAIM W 1 U/4h1 dAUZ DATE
ADDRESS 2T- 3 13C)C 56
�}D144,4c-f- AIC- 2-7&vC X119--x/36/ LOCATIO1! G2AtiF t 20
LOT SIZE Z • s �- 2 �2
TOPOGRAPHY:
SOIL MUM:
SOIL STRUCTURE: I ij Z �hv6u<<c yt BLazj
DEPTH:
RESTRICTIVE HORIZOUS:
PERCOLATION FATE: Presoak Hark & time Drop Time Fate/ldn. Inch
1. 3 o:�2' v24fS
1h,---
3. Tf2
***CLASSIFICATIOII:Suitable Provisionally Suitable suitable
COM-1ETITS:
SANITARIAH S?�AS
SITE DIAGM&M
A
I
0
0
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMEIlTAL HEALTH SECTION
P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATEMENT FOR SEPTIC TANK IMPROVEMENTS PERUMITS AND/OR SITE EVALUATIONS
NAME l�1 t lly Arm CAV U t �. DATE,(D
ADDRESS . SL PERMIT N0.2-"79�
EXPLANATIO14 OF CHARGE J lTf- f-Vhc.VArw,. l I r^PP-oV'r'y L.xs e
A11120UNT DUE Zo SANITARIAN
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.