431 Dalton RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PEWIT Date Lo —,76 --�3
),Amer/Occupant,_ To: �� �t �•
Address , v / Address ,
Building Contractor Address
Cal. D D Manufacturer's Name Address `
No. of lines _ Width � n. Total length ft. No. sq. f
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Type of filter material Total tons used
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Minimum REquirements: House Trailer Tank cap.. 800 Sq. ft. line 400
600
Two-bedroom house 800
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 instal ed according to specification
Signed:
Syeppttaifcf�_T ank �nractor
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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