P42673 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK EFJ,1IT Date
Owner/Occupants—ice rok / A To:
Address � 140 C__ks ✓ Address E
Building Contractor Address ��DD
Cal. a a Manufacturer's Name
No. of lines r�— Width ,�% � in. Total length /1)o ft. No. sq. ft. Soo= hoz
Type of filter material Total tons used o2 a
e
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 thle Health Offi<
or his agent.
Date of Final Approval
Signed: r
Sanitarian
I hereby certify that the above septic tank has been instaled according to specification
Signed:
ep is Ta o rac r
Note: Make sketch of disposal system on back of sheet and mail to avie County Health
Center, Box 57, Mocksville, North Carolina 27028.
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