P11673 Cornatzer RdDAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK PERMIT Date Z l—
t, — 7
Owner/Occupant
To: i
Address
Address
Building Contractor �`
Address
Cal. �� Manufacturer's N e
Address
No. of lines w�_ Width F-in. Total
length / D a ft. No. sq. ft. D o
Type of filter material
Total tons used._ .
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:
Sanitarian
I hereby certify that the above septic tank
has been installed according to
specification
Signed:
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.
F-�
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