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DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
Okmer/Occupant 19m; a C�jK/ s• To: 1 r
Address 4;1,q;XOcr - Address /2, r
Building Contractor
1` Address
9
Cal. r> manufacturer's Name � � �, Address I i
No. of lines _ _Width _2& in. Total length ` 75Z'3—_ft. No. sq. ft. ,5oa
Type of filter material gzn_ 2 Total tons used
Minimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 600
} Two-bedroom house 800
Three-bedroom house
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-accordin to specificatiox
cl��C /Q l(nctj Signedx. / /
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.