Wood Valley Club House, DAVIE� COUNTY HEALTH DEPARTMENT- SEPTIC TANK PERMIT Date
Owner/Occupant �Q To:
Address Address
Building Contractor Address
Cal. �a Manufacturer's Name ( Address y
No. of lines �_ Width _sl_74 in. Total length d ft. No. sq. ft. 34 o Z�
Type of filter material �,.,oT_ Total tons used 33
Hinimum REquirements: House Trailer Tank
Two-bedroom house
Three-bedroom house
No one shall install a septic tank in Davie
or his agent.
Date of Final Approval
S
I hereby certify that the above septic tank
cap. 800,, Sq. ft. line 400
8OO600
-----`"900 900
County without'a permit from the Health Offic
i
Signed:
Sanitarian -�
has been installed according to specification,
Signed:___.
Sept' Tank Contractor I
l
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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