180 Center Circle Lot 23DAVIE COUNTY HEALTH DEPARTMENT
Jwner/Occupant
Address
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SEPTIC QTj
To: V4
_ / Address _
Building Contractor 1, Q �i le c� �c Address
Cal, 904p Manufacturer's NameAddress
No. of lines / Width _,i Lin. Total ength C9,60- i. �
Z.
PERMIT
Dat
sq. �ft.l b0
Type of filter material Total tons used
Minimum REquirements: House Tr ler 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 a ZSigned: e( -.A/
a arian
I hereby certify that the above septic tank has been insta led according to specification
Signed: Q
epti Tan Co tractor
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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