395 Michaels RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK P RMIT Date
Owner/Occupant -,� _ ��.1� htrn _ i c-----_
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Address A,l - %'" �� Address L9 C;7 �
� r4�� Address
Building Contractor
,.
Cal. ,9�
Manufacturer's Name I I Address
No. of lines _�_ Width z/6n. Total length le -_z) ft. No. sq. ft.
Type of filter material Total tons used j
Minimum REquirements: House Trailer Tank cap.0Sq. ft. line 400
Two-bedroom house �.8b0� 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.