P92173 Angell RdI
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date !
Jwner/Occupant 5 SPT To: Z±L", (- /� % — //,
Address Address
Building Contractor `��Ai /�� Address
Cal. 9h) --Manufacturer's Name �Address _141
No, of lines ��` Width (in. Total length ft. No, sq. £t,Q
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 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 ccordin t speci..catiot
Signed:
od.
Septic T,4nk Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
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