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DAVIE COUNTY HEALTH DEPARTMENT
JHmer/Occupant %hQ Pt W
Address
Building Contractor Lay e4l Ak44 d >
Cal. Manufacturer's Name
SEPTIC TANK PERMIT Date
To:
7 -
Address
Address
Address
No. of lines Width in. Total length
Type of filter material Total tons used
ft. No. sq. ft.
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.