214 Laird Rd and 6
VIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
Jwner/Occupant lc Jam _ -__� To:
Address
Address e
]
T
Building Contractor / Address
Cal. Manufacturer's Name Address
No. of lines / Width in. Total length /M ft. No. sq. ft.
Type of filter material �7/ ,- --
Total tons used o7 0�
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: / gin,
optic T nk 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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