P11170 FosterDAVIE COUNTY HEALTH DEPARTMENT
Jumer/Occupantplll- ,
Address
Building Contractor to"'01 t�
Cal. Manufacturer's Name
SEPTIC TANK PERMIT Date 0" '� p
To:
- J�
Address
Address `
Add ss
No. of lines Width in. Total length
Type of filter material Total tons used
Hinimum REquirements: House Trailer Tank cap.
Two-bedroom house
Three-bedroom house
ft. No. sq. ft.
800 Sq. ft. line 400
800 600
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 specificatior
Signed:
Septic Tank 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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