P22874 Etchison StDAVIE COUNTY HEALTH DEPARTMENT SEPTIC ANK PERMIT Date Ly
/ Jcmer/Occupant 1441111%Qi71 4QI71 To:
Address��/,cIr ; _ Address `
Building Contractor Address
Cal. Manufacturer's Name Address
No. of lines Width in. Total length ft. No. sq. ft.
Type of filter material Total tons used t3,5— - 4-0 60
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Minimum REquirements: House Trailer Tank cap. 080000 Sq. ft. line 400
Two-bedroom house 800 il
Three-bedroom house 900 9
No one shall install a septic tank in Davie County without a permit from the Health',Offic
or his agent.
Date of Final Approval 5>7 - �-,�—� �" Signed: /1 i
Sa,Aitarian
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.
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