P9172 Greenwood LakesDAVIE COUNTY HEALTH DEPARTMENT
Owner/Occupant��
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SEPTIC TANK PERMIT
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Date
ress,�L� ,( ,c�•� Q Address
Building Contractor ZJ1, '�' Address
Cal. Manufacturer's Name Address
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No. of lines Width
Type of filter material
in. Total length
Total tons used
ft. No. sq. ft.
Minimum REquirements: House Trailer Tank cap. 800 Sq_. ft. line 400
Two-bedroom house 800 600
Three-bedroom house � 900
11 C 04
No one shall install a s ptic tank in Davie County without a permit from the Hea yoo ffic
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 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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