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DAVIE COUNTY HF,ALTH DEPART MT
SEPTIC TANK PERJIT
No. of Dedrooms 3 Date /— a 5— G r,
This permit is granted to T� (:C% 7� for the installation of
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a Septic Tank at the residence of � it ow � Address C a � (2 1e ht e fL
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Building Contractor 11 Address
Septic Tank Specifications: Length t7idth Depth Capacityl���Gal�
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Manufacturer t s Name c�uc� Address
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No. of lines Width in. Total length Ft. No. of Sq. Ft. 'D
Type of filter material � !�~� Total tons used � 7
Minimum Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 100
Two -Bedroom House 800 600
Three -Bedroom House 900 900 r
No one shall anstall a septic tank in Davie County without a permit from the
Health Officer or his agent.
Date of final Approval —o2 9 — Ei Signed:t
Sanitarian
I hereby certify that the above septic tank has been installed according
to specifications.
Signed
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.
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