P2869 Hwy 601SDAVIE COUNTY HEALTH DEPARTMENT
-" IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
*Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Name
Location
Date
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 E] NO C)y.f �;,� _ � ,.; f ;,; y�f •ef, -41Auto Wash Machine YES E] No -F-1
Type Water Supply _
J
*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. ,
w
Final Installation Diagram: System Installed by 'TOC 1:-�T« �7C7,1%10
(� ',) - C/
Certificate of Completion U' 0\ 0,A- A Date I ��
*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 COUFTTY HEALTH DEPART TENT
ENVIRONMENTAL HEALTH SECTION
SOIL/SITE EVALUATIO17
VAME DATE it- So I
ADDRESS
LOT SIZE
SIZE
TOPOGRAPHY: ?S
SOIL TIM URE: �S
SOIL STRUCTURE:5
DEPTF. :5
RESTRICTIVE HORIZOVS: u —
PERCOLATION PATE:
1.
2.
3.
LGCATI014 (p c) I - T, R - l`{
'e .
Presoak
Aiark & time
Drop
Time
Pate iiin. Inch
12'�
%**CLASSIFICATIOiT
Suitable Provisionally Suitable Unsuitable
C0101TEITTS :
SANITARIAN h'-xt--L
SITE DIAGRAM
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