3240 Hwy 601NDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
' *Note:-{csued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name r; r ` Date t l 1
Location
Subdivision Namle
Lot Size
No. Bedrooms.
Garbage Dispo:
Auto Dish Wast
Auto Wash Mac
Type Water Su
*This permit Vc
Lot No.
Sec. or Block No
House Mobile Home _ Business Speculation
No. Baths No. in Family
11 YES ❑ NO p' Specifications for System:
r YES Q NO ❑
ine YES p NO ❑
ply
9 if sewage system described below is not installed within 36 months from date of issue.
Improvements permit by
*Contact a repr 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 Installation Diagram:
System Installed by.. _ ^�
Z r/i ((-
Certificate of Completion L��i� Date°,
*The signing o this certificate shall indicate that the system describ d above has been installed in compliance with
the standards et forth in the above regulation, but shall in NO way be taken as a guarantee that the system will function
satisfactorily f r any given period of time.
,t
VAIT .�
ADDRESS
LOT SI
TOPOGR
SOIL T
SOIL S
DEPTH:
RESTRI
SITE
DAVIB COUPTTY HEALTH DEPARV ENT
ENVIRONI-M TTAL HEALTH SECTION
SOIL/SITE EVALUATIOY
'HY : S
.TURF: S
.UCTURE
'IVi: HORIZOUS:���
DATE 3��c+
LOCATION
IOPT FATE: Presoak Ifark & time Drop Time Pate iiin. Inch
1.
Z.
3.
IFICATIOIT:Suitable Provisionally Suitable Unsuitable
F",
SAVITARIAN
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