262 Michaels Rd�!
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DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date q ' /,9
Jumer/Occupant C._.r l::i, S Rog I,?S, T., To: _94,1n �c4 ✓ jy
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Address f�-1,�/3 � o�.fc�sy c /� � Address /� �JQrmatiri
Building Contractor 44 71es-4< uja-r s Address y,
Cal. 17,00 manufacturer's Name Address 1� '
No. of lines ,� Width 40in. Total length ft. No, sq. ft.-----�-_
Type of filter material �� Total tons used
Minimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 9900017 20�
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 Ta ontractor
Note: Make sketch of disposal system on back of sheet and mail to avie County Health
Center, Box 57, Mocksville, North Carolina 27028.