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DAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK PERMIT Date
e—.
JHmer/Occupant ,oe
To:L Lgy�p?a
�,fs
Address T jl
Addxess,
Building Contractor `�11--�
Address
Cal.Manufacturer's Name ^ cti.'�
Address
No. of lines. width �36in. Total
length C7 CD ft.
No. sq. ft.
�? od
Type of filter materialLp
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 Offi<
or his agent.
Date of Final Approval/J-�a? Signed:
S` tarian
I hereby certify that the above septic tank has been install acc7z_
g to pecificatiox
Signed: ,
wept c ank ont ctor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.