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DAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK PERMIT
Date
Jkmer/Occupant 82J-4z-�
To: � 5.7
cf�..
Address �7,10-
Address
Building Contractor
Address/ X�-
Cal. Manufacturer's Name J�S T da
Address
No. of lines __.__-Z_ Width -L2n. Total length o2aS- ft.
No. sq. ft.
v�
Type of filter material Z/z�,-
Total tons used
.30
Minimum REquirements: House Tra'ler Tank cap. 800 Sq. ft. line
400
Two-bedroom house
804------
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:
Septic Taft Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.