263 Pete Foster RdDAVIE 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
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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 fl NO E] Specifications for System:
Auto Dish Washer YES p NO
Auto Wash Machine YES [ NO
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
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f
i provements 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 �', « -�� 4-
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
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 E NO Ey Specifications for System:
Auto Dish Washer YES ❑ NO Q '
Auto Wash Machine YES [j NO I] -
Type Water Supply
*This permit Void if sewage system described below is not installed within 36 months from date of issue.
provements permit by
*Contact a representative of the Davie County Health Departnt for final inspection of this system between 8:30-
9:30 A.M. or 1:00-1:30 P.M. on day of completion. Telepho Number: 704-634-5985.
Final Installation Diagram: Syste Installed by
134yj,,}'i�`�
. J
�L
Certificate of Completion Date b
*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.