P2787 John BuchannanDAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
` `Note: Issued in Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Name <_! ,f +,; ., r c ,' y; /i ,; % Date
.r
Location "i"
Permit Number
`- i t 9
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home Business Speculation
No. Bedrooms No. Baths—Z �'' No. in Family
Garbage Disposal YES ❑ NO p Specifications for System:
Auto Dish Washer YES ❑ NO p'
Auto Wash Machine YES Ey, O ❑
Type Water Supply
`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.,
Final Installation Diagram: System Installed by �'< ;-f
Certificate of Completion '1/ '�'/�t' /d
p Date
*The signing of this certificate shall indicate that the system described abo q/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 COUNTY HEALTH DEPART TEcTT
ENVI11OP ENTAL HEALTH SECTION
SOIL/SITE EVALUATIO11
VAIM J i v.� /"i�
ADDRESS
. s
LOT SIZE
TOPOGRAPHY: S'
SOIL TE,'xTURE a
SOIL STRUCTUREs,or�
DEPTH: �/ F *r "',
RESTRICTIVE HORIZOVS: " P
PERCOLATION PATE:
1.
2.
3.
DATE �/
!�5! FI'
LOCATIO14
Presoak
Mark & time
Drop
Time
Pate Tin. Inch
***CLASSIFICATIOIT:Suitable Provisionally Suitable Unsuitable
COI1j:MITS s
SAPTITARIAH
SITE DIAGRAM
STATEMENT
MELON HEALTH EPARTMENT
HOSPITAL STREET
P: O: BOX 865
MOCKSVILLE, NORTH CAROLINA 27028
DATE
DETACH AND MAIL WITH YOUR CHECK. YOUR CANCELLED CHECK IS YOUR RECEIPT.
s ¢ z
FORM F082 Available from GRAYARC CO., INC., Brooklyn, NY 11232