146 Mr Henry RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PEW,1IT Date
Ovmer/Occupant (,C (Y;,,. j� To: ,113-6
Address 'V, �� Address
Building Contractor Address
Cal. v Manufacturer's NameAddress
No. of lines _� Width in. Total length 1;LL-) ft. No. sq. ft.---F--=—
Type of filter material�D Total tons used Is
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 specificatioT
Signed:��t-Gj
Septi,6 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.
ON � Y
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