2684 Hwy 801NDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date 4=1a - 9
Jwner/Occupant Li uPjt�_S To: ��
Address p — Q�,K,� vZ�
,��1 F �c�?,T/v�Q� Address
Building Contractor Address
Cal. ap Manufactu 's Name Address S.., �
No. of lines _ Width 3 o�in. Total length do -.S ft. No. sq. ft�7.` (,?sem--����
Type of filter material Total tons used 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 installed csq'ror
j Signed:
A> t"� l am.. 30 Septlic 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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