1014 Wyo Rd (2),A
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DAVIE COUNTY HEALTH DEPARTMENT
Jumer Occupant
Address 44
Building Contractor
SEPTIC TANK PERMIT Date f--
To:
Address
Address
Cal. 9 yanufacturer's Name Address
No. of lines Width _in. Total length
Type of filter material
Total tons used
ft. No. sq. ft.
Minimum REquirements:
House Trailer Tank cap.
800
Sq. ft. line 400
3 Q'�����a`l�'r'
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.