4554 Hwy 64 WDAVIE COUNTY HEALTH DEPARTMENT „
'IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
-*N t% Issued'iri-,Compliance with G:S: of North Carolina Chapter 130—Article 13c:
Permit,Number
Name ;i-'�i ® .�� `� . %�� Date 14 ,� /.0 tu' 2759
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business e!!! Speculation
No. Bedrooms' ' No. Baths i No. in Family'a
Garbage Disposal YES IEj NO []s''- Specifications for System: t
Auto Dish Washer . YES ❑ NO .'ED.
Auto Wash Machine, YES ❑ NO ,[.�''`�!(✓(., �� i r
Type Water Supply ,��J.�,9�.6'--
,�
*This permit Void if sewage system described below is not installed within 36 months from date of- issue.-
-
//Z j
it
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 1:004-30 P.M. on day of completion. Telephone Number: 704-634-5985.
Final Installation Diagram: System Installed by
I
11
Certificate of Completion 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 astabguarantee that the system will function
satisfactorily for any given period of time:
I - t
DAVIE COUNTY HEALTH DEPART_IEWT
ENVIRONDENTAL HEALTH SECTION
SOIL/SITE EVALUATIOU
PAME U C r.`i % /fi ��t%� DATE
ADDRESS
LOCATIO:d
LOT SIZE
TOPOGRAPHY:
SOIL TE:'TURE : S
SOIL STRUCTURE:
DEPTH:
Alf,'
RESTRICTIVE HORIZOFS: h/jp/,/-C
PERCOLATION FATE:
2.
3.
Presoak
Hark/ & time Drop
Timej�
Pate/ iin. Inch
C/
*** CLAS SIFICATIOPI :
Suitable Provisionally Suitab Unsuitable
COMMEUTS
V
SANITARIATI
SITE DIAGF.ANi
L:M W di
DAVIE COUNTY HEALTH DEPARTMENT
ENVIRONMENTAL HEALTH SECTION
P.O. BOX 57
MOCKSVILLE, N.C. 27028
(704) 634-5985 111
STATEMENT FOR SEPTIC TANK IMPROVEMENTS PERMITS AND/OR SITE EVALUATIONS
NAME >4,":=- S DATE /. /F Ael
UV
ADDRESS ZPERMIT NO. LX' ! 'r
EXPLANATION OF CHARGE
AMOUNT DUE S � SANITARIAN �e.Z
PLEASE REMIT THE ABOVE'AMOUNT OF RECEIPT OF THIS STATEMENT.
*NOTICE: Evaluation(s) can not be completed until payment is received.
Improvements Permit(s) can not be issued until payment is received.