P11574 John A Foster, SrNote: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
DAVIE COUNTY
HEALTH DEPARTMENT
SEPTIC TANK PERMIT Date —
Jtimer/Occupant
,
To: � S I ( "
Address
Address ilk
Building Contractor `
Address'/A�
Gal, rTanuf ctu
is Name
Address „3
No. of lines rp, Width 3P in. Total length No, sq. ft.
Type of filter material
Total tons used
Minimum REquirements:
House Trailer Tank cap. 800 Sq. ft. line
400
Two-bedroom house
80
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
�/ J %
Signed: r
l
nitarian
I hereby certify that the above septic tank
has been installe��dacco in �o
pec i tion
Signed: ,
S ptic Ta Contrac t or
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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