P71072 Pino Rd(19 DAVIE C�O JNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date /6,Z2 ->-
Owner/Occupant 112To:
Address`�� _ m uat�_Address rz ; ✓ <<
Building Contractor Address
Cal _,>6b Manufacturer's Name�t Address (, l
No. of lines Width _J�_in. Total length ft. No. sq. ft. DD
Type of filter material Total tons used -
Hinimum REquirements: House Tra' r 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: �/�
Septic Tank 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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