P2967 Wayne Godbey' DAVIE COUNTY HEALTH DEPARTMENT
IMPROVEMENTS PERMIT AND CERTIFICATE OF COMPLETION
'Note: Issued n Compliance with G.S. of North Carolina Chapter 130—Article 13c.
Permit Number
Name ' Date„ t'
Location
Subdivision N me Lot No. _ Sec. or Block No.
Lot Size j House Mobile Home — Business Speculation
No. Bedrooms No. Baths No. in Family
Garbage Disposal YES ❑ NO:p- Specifications for System:
Auto Dish Wass,her YES E] NO
Auto Wash Machine YES Q NO ❑
Type Water S pply + _ ? % ✓
*This permit pid if sewage system described below is not installed within 36 months from date of issue.
rte' t�Ij Improvements permit by
[ f 1 U --
*Contact a re resentative 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
i
r
Certificate of Completion / i'r�' �'�
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 as a guarantee that the system will function
satisfactorily for any given period of time.
T_- t L1
k
PAME
DAVIE COUP?TY HEALTH DEPARTMENT
EPIVIROYMEIITAL HEALTH SECTION
SOIL/SITE EVALUATIOF
DATE �}
LOCATION
LOT SIZE
TOPOGRAPHY:
SOIL TI MPTURE :
SOIL STRUCTU EP
DEPTH: _ t b
RESTR CTI"JE HORIZOVS : 6tlewe
PERCO ATIOIt RATE:
1.
2.
3.
Presoak
14ark & time
Drop
Rate Hin. Inch
V
.Time
�.30
e5 a
***CLSSIFICATIOPI: T
S itable � Provisionally Suit Unsuitable
COI2,IEP TS :
SANITARIAN
SITE bIAGFAM1