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DAVIE COUNTY HEALTH DEPARTMENT
Owner/Occupant
SEPTIC TANK PEWAIT Date
To: �T-
Address Address
Building Contractor C,a,��/1 �- div Address
Cal. -7310 Manufacturer's Name VIC 5�7-_- Address ,Aaf—�L
No.'of lines Width 4or in. Total length , ' ft. No. sq. ft. 're;
Type -of filter material /c^# Total tons used 'j e
Minimum,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 akent.
Date of'Final Approval
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specification
Signed:B�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.