P3810 Gladstone Rdt 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 ice) �r i� :� %% %�i �` Date d '/�� (1� ? n
Location �; .; )�:/
Subdivision Name Lot No. Sec. or Block No.
Lot Size -r "� y House Mobile Home — - " Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO ❑- Specifications' fo`System:
Auto Dish Washer YES ❑ NO ❑ �CCr<)t`, �1E'h.
Auto Wash Machine YES p NO -❑ (Z
Type Water Supply 1-1'� .�i t l' _— .� `;/"- '* /
`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.
a
Certificate of Comp letio,<��ML-- 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.
LDAVIL COUITTY HEALTH DEPARTIEITT
-j
EITVIROITI-MUTAL HEALTH SECTION
SOIL/SITE EVALUATIOV
IIAI4E DATE
ADDRESS / S�
LOCATION
LOT SIZE Z T 'ye
TOPOGRAW Y
SOIL TE',�TURE e�lu� y
� S
SOIL STRUC MG e
DEPTH: !� �
v1
RESTRICTI`FE HORIZOUS: ne r
s
PERCOLATION PATE
1.
2.
3.
Presoak
Hark & time
Drop
Time
Rate/iiin. Inch
** *CLASSIFICATIOI?Suitable Provisionally Suitable Unsuitable
COMIEUTS s
SArITARIAIT �� ��
SITE DIAGRAM