142 Pino RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC •TANK PERMIT Date
Oumer/Occupant %�,,���� r To:
Address p7yc�� ee- Address
Building Contractor ,Qnzp,s—c�c�fifc g Address 9(�7(, /� �yrinony
Cal. 9&b Manufacturer's Name ee7Addresses
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"10. of Lines / Width �in. Total length �� ft. No. sq. ft..9 dC�
Type of filter —material C� Total tons used 7 3 o
Hinimum 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: 11
Sanitarian
I hereby certify that the above septic tank has been installed according to specification
Signed:
Septic Tan 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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