316 Stroud Mill RdDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`KLote• Issued in Com liance with G S of North Carolina Cha for 130—Article 13c
Permit Number
z� 114
/iGJ.• / r'� I/r r' -J ='�' Cl is r •�
Name , ✓ Date
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 0
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Specifications for System:
Auto Dish Washer
YES ❑ NO .Q
Auto Wash Machine
YES NO ❑
Type Water Supply
r i
`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:
w X/
System Installed by,'/.",
f
r
Certificate of Completion L 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 function
satisfactorily for any given period of time.
DAVIE COUPTY HEALTH DEPART IEI?T
ENVIROIII-MITAL HEALTH SECTION
SOIL/SITE EVALUATIOU
ADDRESS AL %'
LOT SIZE ZA /
TOPOGRAPHY:
SOIL TE21.TURE :
SOIL STRUCTURE :`-
DEPTH:
RESTRICTIVE HORIZOUS :
PERCOLATION PATE:
1.
2.
3.
DATE
LOCATIO1 �. C
Presoak
11ark & time
Drop
Time
Rate/iii%. Inch
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%*CLASSIFICATIOIj:Suitab a Provisionally Suitable Unsuitable
COMMEIITS : l�Aw/, �x /✓ .4i/�!� il/',-Vr `- /x/ -o �A �� /,/ve,-,
SAA?ITARIAs7
SITE DIAGPAY1 '
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRON14EIlTAL HEALTH SECTION
P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985
STATEIEIJT FOR SEPTIC TAI4K IMPROVEMENTS PER�'KITS AND/OR SITE EVALUATIONS„
NAME �/ Y �� DATE
ADDRESS PERMIT NO. r
EXPLANATION OF CHARGE lc,^1�ij ; ;,1�y';i••-��y/��J �.,+t�:=i'�yi�!
AMOUNT DU�^�, � SANITARIAN
f
PLEASE REMIT THE ABOVE AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be complateduntil payment is received.
Improvements Permit(s) can not be issued until payment is received.