P81072 Mocks Church Rd 16 bks dhatA WE
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
tamer/Occupant Q r7 a►- To: ` 17'rz 6511:71.
Address/ e)e_�s �/i•��,�I i �� �dya tic e Address c IC
Building Contractor Address
Cal. 10-ap Manufacturer's Name Address8 3
No. of lines Width _46. Total length ft. No. sq. ft. S oz
Type of filter material Total tons used
Minimum REquirements: � House Trailer Tank cap. 800 Sq. ft.jline 400
Two-bedroom house 800 600
Three-bedroom house 900
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No one shall install a .ptic tank in Davie County with/ out a permit from the Health Offic
or his agent. 3 // ala soa
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specification
'ods
Signed:
Septic Tank Contract/or
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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