P41373 Liberty Church RdDAVIE COUNTY HEALTH
/DEPARTMENT SEPTIC TANK PERMIT Date
tamer/Occupant/��(S To:
17
Address s - Ad7ss
Building Contractorn a 6--r-- Address
Cal. oo Manufacturer's Name Add ss�1:.r
10. of lines Z_ Width ?�-in. Total length ft. No. sq. ft. a
Type of filter material 4 Total tons used
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.
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been instal accord' g to specification
Signed: _
ptic Ta Contra or
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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