Derrick Barnhardt - AdvanceDAVIE COUNTY HEALTH DEPARTMENT
Jwner/Occupant C. �
Address
SEPTIC TANK PERMIT Date f _/-- 73
To: ��/ .e
Address
Building Contractor Address
Cal. � Manufacturer's NameCr Address
No. of lines l Width s�1. _ly. n. Total length Z 0 ft. No. sq. ft. `3 % a — 5wb
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: [/ n , , , Z]`, _t %,-
:' eptic Ta ontractox
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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