P2992 Cedar Grove Church RdJ,
�. 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--s-It4 } C�(Sc ' Date 5-.� t_�2
Location c ,^� G � tit i&P'
Subdivision Name Lot No. Sec. or Block No.
�p
Lot Size r,N House Mobile Home — Business Speculation
No. Bedrooms G' No. Baths I No. in Family
Garbage Dispo al YES p NO pff -I ti,4%
Specifications for System:'913J �',
Auto Dish Washer YES E] NO El
Auto Wash Machine YES b NO p
Type Water SL pply
*This permit V id if sewage system described below is not installed within 36 months from date of issue.
-P
Improvements permit by
*Contact a rep r sentative of the Davie County Health Department for final inspection of this system between 8:30-
9:30 A.M. or :00-1:30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installatioh Diagram:
V
*The signing of
the standards
satisfactorily fo
C
System Installed by
Z
Certificate of of CompletionDate
I
is certificate shall indicate that the system described above has been installed in compliance with
t forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
any given period of time.
DAVIE COUP?TY HEALTH DEPARTMENT
ENVIRONMNTAL HEALTH SECTION
SOIL/SITE EVALUATION
r"
I1AIE�3 �V t f DATE d Z.
ADDRESS 1 �� �� � of
t�ILL�
Ale— Z7o'z.,K- LOCATIO14
,'LOT SIZE !U `I /�r-.
t� t
TOPOGRAPHY: f-5
SOIL TE,,TURE: ,�i7 c/
SOIL S RUCTURE: S
DEPTH:
RESTRI TIVE HORIZONS:
PERCO TION RATE:
.._ 1.
2.
3.
Presoak
Mark & time
Drop
- Time
Pate Iain. Inch'
I>1
P jd 114-0
)"
1
** *CLA SIFICATIO
Suitab Provisionally Suitable Unsuitable
COMMIT CS:
SITE DCIAGP"i
SANITARIAPI