P41072 Pineville RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
Jumer/Occupant hnH K ; X To: S
Address Address
Building Contractor l r— Address
Cal. Manufacturer's Name , Address 2C
No. of lines 9L,._ Width �3 4,in. Total length �� d7 ft. No. sq. ft.
_ fro�E�
Type of filter material 9f,3 Z,__Total tons used ,sr-
'7
Hinimum 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 installed according to specification
Signed: f&_1
Septic Ta k 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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