P52572 Ridge RdDAVIE COUNTY HEALTH DEPARTMENT
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Jumer/Occupant C !f �y
Address �7'i/,ti ?0
Building Contractor
Cal. Oct Manufacturer's Name
No. of lines % Width Total lengt
SEPTIC TANK PERMIT Date./?�
To:
Address
Address
T
%�& ( Address c
h / Nim ft. No, sq. ft.
Type of filter material /�?�7,}�}Zv`� Total tons used
Minimum REquirements: house TrailerTank 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: _ J C -z'
Septic T nk 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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