3980 Hwy 601S&p ojq OKE Y-,7
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date —
Owner/Occupant jtrArWirnz
Address42
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Address.
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Building Contractor
Address
Cal. Manufacturer's Name���p �,
„ Address
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No. of lines Z Width �Irin. Total
length ft. No. sq. ft.
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Type of filter material
Total tons used %�,�
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Minimum REquirements: House Tr9iler 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 T nk Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.