CooleemeeDAVIE COUNTY HEALTH DEPARTMENT
Jimer/Occupant
Address �c�/eP fcreF
SEPTIC TANK PET,1IT-Daat-e ,�3r 73To: �./�
Address ZZ
Building Contractor Address
Cal. f ?,D Manufacturer's Name eaa Address
No. of lines . I Width in. Total length /00 ft. No. sq. ft. 00
Type of filter material gtz;5 Total tons used Z6
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 install accor o sp ificatioa
Signed: O -z" 411vj! -
fSeptY 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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