P2772 Peoples Creek Rd• _ r
A DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
`Note: Issued Compliance with G.S. of North Carolina Chapter 130—Article 13c.
' .: Permit Number
Name t , I=' tt.> .i . c i'r s i :{ Date _ 7 P
i.
Location
Subdivision Name
Lot No. Sec. or Block No
Lot Size ` / �� House Mobile Home — Business Speculation
J .
No. Bedrooms No. Baths �f�- No. in Family
Garbage Disposal YES ❑ NO .❑`� /00
_.
Specifications for System:
Auto Dish Washer YES ❑ NO ❑ r, , I,
Auto Wash Machine YES � NO ❑ � (� J is " -, 1 w ; , .F �. -"
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
c"
Improvements permit by
ii
*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:
System Installed by
2-
Certificate of CompletionDate
*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.
A
DAVIT COUIETY 11EALTH DEPART 1E TT
EPTVIT101THENTAL HEALTH SECTION
SOIL/SITE EVALUATIOP?
I?AIS k w `�� R C K DATE 7- zo
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ADDRESS �
�I�VJL WL COG
'? /� . LUCATIO.4
LOT SIZE S D ' ` q-yz Z r
TOPOGRAPHY: FmrL,
SOIL TE ;TURE : 5 A4YVD i Gam,..
SOIL STRUCTURE:
DEPTH: S
RESTRICTME HOFIZOVS: N,, -,�-
PERCOLATION FATE:
1.
2.
3.
***CLASSIFICATIO ,:
Suitable Provisionally Suitable Unsuitable
C0111EITTS :
t
Presoak
Hark & time
Drop Time
Pate/Tin. Inch
d
2)(L.
10 „w
10
SAI`?ITARIAPT ��—
SITE DIAGFAPi
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