P9872 Hwy 64W011
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date r
Owner/Occupant To S-. T.,
Address �� - Address
Building Contractor Address
Cal. _ eg Manufacturer's Name ` ; Address
No. of lines ^ Width __�o Zn. Total length _2 07 ft. No. sq. ft. 2,06
Type of filter material p Total tons used 3d-3�,.._-
Minimum REquirements: House Traile 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 sp
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�ication
Signed: ��✓%-L�2 , 4hT(/
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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