P4572 Hwy 601SDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date�;',�ri�
Jumer/Occupant :%. Fra ;f C2. t)) es _ To: ,(�� /�; L2 (
Address �/�Jp� k, 7 Address
�(�f �7 r��d A-- fie
Building Contractor 4 t %�� JAddress
Gal.pD Manufacturer's Name�j p q Address �j (3's;�
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No. of lines / }9idthin. Total length / ft. No. sq. ft. 3 2y
Type of filter material itic, Total tons used o2
Minimum REquirements: House Trai er 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 according to specification
Signed: c-.
Septic Tank Contras or
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.