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DAVIE
COUNTY HEALTH DEPARVHENT SEPTIC TANK PERMIT
No of Bedrooms
Date
.�
This permit is granted
to n
�`S for the instal a
'on of a
s ptic tank
at the residence of
o
c Address �5�,
Dc:_
c �S ,
Building Contractor
Address,
Septic Tank Specifications: Length
Width Depth Capacity
Gal. 940,0
Manufacturer's Name
0 q 7C
Address
No of lines_ width
3 l in. Total
Length Zo jLft . No. of
Sq. , t
Type of filter material i
Total tons
used �t5�
Minimum Requirements:
House Trailer
Tank Cap. 800
'�:
Sq. ft.
line 400
Two-bedroom ho
se- 800
600
Three-bedroom house 900
900
No one shall install a septic tank in Davie County without a permit from the Health
Officer or his agent.
Date of final approval Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications. � /J
Signed: (ti�az> E&6--f-
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.