1168 Calahaln RdDAVIE COUNTY HEALiPi DEPARTMENT
Owner/Occu ,ant
Addressp.
Building Contractor
ual. Yza-d Manufacturer's Nam
No. of lines Width in. Total
Type of filter material
SEPTIC TANK PERMIT Date9,..o_ 73
r
�. Address
Address
ddre s sCi�
length 7 ft. No, sq. ft. Ci
Total tons used
m REquiremen House Trailer Tank cap. 800 Sq. ft. line 400
Two-bedroom house 80 600
/TRr—ee_-Te7_r3`5F-F6—use�)
No one shall install a septic tank in Davie County without a permit from the Health Offic
or his agent.
9
Date of Final Approval C Signed:�
Sanitarian
I hereby certify that the above septic tank has
been install rxaccor=o spe ificatioz
Signed:�'
Septi 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.
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