P103172 FosterDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date0!�:' L
)timer/Occupant, f. ,� °-2 To: �ez2c�'
Address Address %
Building Contractor , _ Address Jffi f,
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Cal. -�� manufacturer's Name , �x— Address LvA r
No. of lines rZ Width _,�in. Total length ft. No. sq. ft. b —
Type of filter material Total tons used
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 specification
Signed:K?j .N QaAA4—
• S pt 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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