P2106 Glenn FosterJ0
Jam"' DAVIE 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 Date
Location
Subdivision Name Lot No. Sec. or Block No.
Lot Size House Mobile Home _ Business Speculation
No. Bedrooms `
_ No. Baths No. in Family
Garbage Disposal YES ❑ NO ❑ Specifications for System:
Auto Dish Washer YES ❑ NO❑ �� �- >
Auto Wash Machine YES ❑ NO ❑ �� �- �-���
Type Water Supply s n'v 'Vn�r..!
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
t
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.
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 as a guarantee that the system will function
satisfactorily for any given period of time.
DAVIE COUNTY HEALTH DEPARTMENT,
P. 0. BOX 57
HOCKSVILLE, N. C. 27028
(704) 634-5985
Statement for Septic Tank Improvement P.ermitS
and/or Site Evaluations
NAME��"/��i11�7/t 1 /�d� DATE ISSUED
ADDRESS PERMIT NO.
Explanation of char a fih ,E,G t
AMOUNT DUE ; � SANITARIAN s ��
PLEASE REMIT THE ABOVE AMOUNT ON RECEIPV OF THIS STATEMENT.