P111273 Wood Valley Lot 87DAVIE COUNTY HEALTH DEPARTMENT
JHmer/Occupant
Address
Building Contractor�,ck
Cal. qoO Manufacturer's Name
SEPTIC TANK PERMIT Date j/—1,2
To: f'
Addre ,5
Address
Address
No. of lines — .1 — Width 3 PC _in. Total length _7Z6— ft. No. sq. ft. 0 ZS—
Type of filter material J Total tons used Z Z/
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 cificatior,
Signed: P�
Sept,'6 Tank Contr9ttor
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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