277 Pleasant Acre Dr (2) 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 JUS �%; ,-.�, � �„ �� Date / r. � .•+A
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 Q---'NO ❑
Auto Wash Machine YES ❑ NO ❑� \' �`) /
Type Water Supply _—
'v
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
,/S ZWil/ 'i
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
Certificate of Completion 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 functio
satisfactorily for any given period of time.
DAVIE COUPTY HEALTH DEPARTIIE ?T
ErIVIR01,11-M VITAL HEALTH SECTION
SOIL/SITE EVALUATIOr
IIA14E /�,��� DATE
ADDRES r /�
LOCATION
LOT SIZE
TOPOGRAPHY:
SOIL TE;;TURE:
SOIL STRUCTURE: lz2l
DEPTH: p1l -14-
RESTRICTIVE, HORIZONS:
PERCOLATION PATE: Presoak Aiark & time Drop Time Pate/ lin. Inch
1.
2.
3.
***CLASSIFICATT��II�OIT,://Suitable Provisionally Suitable Unsuitable n/
SANITARIATI,_`-���'
SITE DIAGRA,i
f�0 �
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P.Q. BOX 57 �� A
MOCKSVILLS, N.C. 27028 l'
(704) 634-5985
STATEIMNT FOR SEPTIC TA14K IMPROVEMENTS PEMMITS AND/OR SITE EVALUATIIO,NNS
NA14E +T _ r/,�a/ S" DATE
4/40 >ADDRESS �, d/ E' ,. �� PERMIT NO.
!T, le, '
EXPLANATIO14 OF CHARGE ` A.
AMOUNT DUE ._ 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.