P3011 Hwy 801SDAVIE 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 �`'-� ' ��<=c ; l t1�l�! S7h'r�T} Date)
Location LTi' 2��'�r lli��- i /!i-2-i^.L a A0V/ir�c�
Subdivision Name Lot No. Sec. or Block No.
Lot Size � ?SAL L House Mobile Home _�''� Business Speculation
No. Bedrooms -7 No. Baths No. in Family �–
Garbage Disposal YES E] NO p
Auto Dish Washer YES q NO
Auto Wash Machine YES E;l NO ,0
Type Water Supply
G 4 -
Specifications for. System: 1000
Z000AEI% fZ
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
Improvements permit
*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:
1A
�3
System Installed by� 0mN/-rZg/z-
Certificate of Completio Date
*The signing of this certificate shall indicate that the system desrabove 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.
DAVIT COUFTY HEALTH DEPART IEUT
ENVIR01,11•11K1TAL HEALTH SECTION
SOIL/SITE EVALUATIOI?
VALE G U 5 STTI-£ !E --r— DATE ,� - Z—
ADDRESS
LOCATION
LOT SIZE
TOPOGRAPHY: S S'�F�Za2✓ S y1J.�
SOIL TE.,.TURE : y y
SOIL STRUCTURE: �S
DEPTH:
RESTRICTIVE HORIZONS: /11iuyl vi Aq- -7 " �16
PERCOLATION FATE:
1.
2.
3.
**CLASSIFICATIOIT
Suitable Provisionally Suitable Unsuitable
COMIEUTS :
SITE
SAT?ITARIA21
Z,�;.rh(£
0
Z
-lark &/ tine
Drop
Time Pate dn. Inch
/Presoak
; ,1 0
I
**CLASSIFICATIOIT
Suitable Provisionally Suitable Unsuitable
COMIEUTS :
SITE
SAT?ITARIA21
Z,�;.rh(£
0
Z