P12472 Milling Rd7i n'
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DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date /„7 — _ -z--
Di
_Di mer/Occupant To.
Address" Address .
Building Contractor Address
Cal. Manufacturer's Name a �,1 , � Address
No. of lines Width fid' in. Total length 2 2 5- ft. No. sq. ft.
Type of filter materia_ Total tons used 3 !J
Hinimum REquirements: House T ailer 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: zedY=-C -
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.