P10272 Howardtown Rdu
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DAVIE COUNTY HEALTH DEPARTMENT
JFmer/Occupant ler r4f 11q At
Address R7�c39S , A%a e-ks vt`17e
Building Contractor
Cal. Manufacturer's Name
SEPTIC TANK PERMIT Date % -,—
To:
Address
Address
Address
No, of lines Width —in. Total length ft. No. sq. ft.
Type of filter material Total tons used
Minimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 1J
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 S7, Mocksville, North Carolina 27028.