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DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
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Ji mer/Occupant 4 4' f To: /l-t
Addressf V� Address T��?
Building Contractor J4171es l f! ��iar ads Address
Cal. OQ Manufacturer's Name _Address
No. of lines _�` Width 4eg' in. Total length x,25' ft. No. sq. ft. �=--
Type of filter material -?:�/p L�i�e Total tons used 3O
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Minimum REquirements: House Trailer Tank cap. 800- - 'Sq. ft. line 400
Two-bedroom house 800 600
6
Three- edroom'House 900 900
No one shall install aseptic tank in Davie County without a permit from the Health Offic
or his agent.
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Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to s ecificatioz
1
Signed:
Septic nk Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
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