P101073 Prison Camp RdDAVIE y HEALTH DEPARTMENT SEPTIC TANK PEIT Date �D � / y—
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Jirner/Occupant NYY uc Y/ To:
Address ( , Address
Building Contractor Address
Cal. 9C/b Manufacturer's Name _ <
�' � ,�° ir Address
ado, of lines Width n. Total length S' ft. No. sq. ft.
Type of filter material 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 installed according to specificatiox
Signed: 41�_, �f�
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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