P71872 Hwy 601S/p
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMITT Date
Jxmer/Occupant�� Gi cci c To :�.c.lt /ti d j
Address D C-Ilf-S v ' Address f
Building Contractor r Address
Cal. Voz> manufacturer's Name�a-,-,_4 ��I i , Address
No. of lines �_ Width _�R_in.
Type of filter material
Total length
Total tons used
ft. No. sq. ft,
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. r�
Date of Final Approval Signed:
nitarian
I hereby certify that the above septic tank has been install d accordi to s ecificatioi
�w
Signed: -cam
pticTank 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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Graae � 3 6 Z�l