216 Liberty RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date 2—,a D – %
Owner/Occupant To: 4�a Ttl�
Address f Address
Building Contractor �7� Address
Gal. �'j� n Manufacturer's Name Address
No. of lines Width 1�46n. Total length ft. No. sq. t. i �---
Type of filter material Total tons used � Kee
Hinimum 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 according to specification
Signed:
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.
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