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DAVIE COUNTY HE TH DEPARTMENT
Jkmer/Occupant
Address
Building Contractor
SEPTIC TANK PERMIT Date
To:_���i
Address
Address
Cal. 5 -fl Manufacturer's Name t rf L % � i Address
No. of lines �_ Width � in. Total length 4,00 ft. No. sq. £t. Op
Type of filter material` Total tons used
Minimum REquirements: House Trai r 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 specificatioi-
� 3 13, A? Ia u se
O lAoUr3-
Signed: /�Z� 4f*9:n('
Septic TaITk Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.