P61972 AngellE�-
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
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Jwner/Occupant , Cid-Cs�� To: X;Lf,�
Address 7 0/
Address %/j 4—, 4
Building Contractor Address
Cal. D U Manufacturer's Name Address
No. of lines �_ Width '� in. Total- ength r-4 O'D _ft. Nosq. ft/ QQ
Type of filter material p 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 instal
Signed:
Note: Make sketch of disposal system on back of sheet and mail to Davie
Center, Box 57, Mocksville, North Carolina 27028.
o specificatio►
ontr
ty Health