240 Greenhill Rd`Y-
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(21
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
Jkmer/Occupant jq,r le'ZJS4 To7:
lddressJ. 7Q ; s v; l� Address
Building Contractorl�z��6' Address
Gal. %O�`D Manufacturer's Name —,�C�u,e1J .I, r Addressl�/
No. of lines _�� Width 44 n. Total length cI D o ft. No. sq. ft. �✓�
Type of filter material a Total tons used
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 specificatiot-
Signed:
Septic ank 6ontractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.