P2825 Cana RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'Note: Issue4in.Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Name
Location
Date _
i
Permit Number
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 p NO ❑ - r ?� ;
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
- --- /,
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
1
✓ ter
Certificate of Completion Date 011
- .
'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 COUPTY HEALTH DEPARTMENT
EIIVIRON1.1ENTAL HEALTH SECTIOrI
SOIL/SITE EVALUATIOIT
I?AIS DATE
ADDRESS
LOCAT I014
LOT SIZE
TOPOGRAPHY: 1 5rJ�l�
SOIL TE,,TURE : -
�r
SOIL STRUCTURE
DEPTH: �
RESTRICTIVE HORIZOUS:
PERCOLATIOU RATE:
1.
2.
3.
Presoak
Mark & time
Drop
Time
Rate11in. Inch
***CLASSIFICATIOIT:
Suitable Provisionally Suitable Unsuitab a"`1
COMMEITTS :
SARITARIAPT
SITE DIAGRAPi