120 Cap Cain Trail (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PE •SIT Date
Jwner/Occupant _ To:
Address&—c-3 �� / %�� �1�.��.
Address I
Building Contractor Address
Cal. Manufacturer's Name Address
No. of lines JWidth _L�, in. Total length / ,$-y
ft. No. sq. ft. zls`a
Type of filter material �1?� Total tons used �S—
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 agent.
Date of Final Approval
Signed:
Sanitarian
I hereby certify that the above septic tank has been installe according to cificatior
Signed:
Sept' Tank Con actor
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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