P71073 Jolley Rd DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date -- /D --73
Jwner/Occupant J,� , JV, To
Address yJ ,���0 /�� C� Address
Building Contractor Address
CalManufacturer's ame � `_p ��. Address /`��
No. of lines �� Width _�_Iin. Total length /,�p ft. No. sq. ft. Da
Type of filter material Total tons used oSL��
Hinimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit from the Health Offic
or his agent.
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed According to specification
1�4�
Signed:
eptic Ta k on actor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Moc ksville, North Carolina 27028.
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