P31373 Cornatzer RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date 3 /3 — M
OAmer/Occupant �7, ;,�_ t TO: /
Address _ IBJ Address
Building Contractor // Address
Cal. Manufacturer's Name Address
No. of lines +_ Width 1 ein. Total length / p e)ft. No. sq. ft. O O
Type of filter material �� Ta n e Total tons used
Minimum REquirements: House Trailer Tankcap. 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 specification
Signed: '
Sept' ank 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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