P41373 Fork Bixby RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date /
Jtimer/Occupant �^ _ To 7
Address Address
� s
Building Contractor Address
Cal. Manufacturer's Name9z'�Q,.'-LP .f . d , Address e 4-
No. of lines �_ Width _zzin. Total length / d -b ft. No. sq. £t.
r
Type of filter material Total tons used &2 -.�4
Minimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 400
600
Two-bedroom house 800
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: :�!GJle—
Septic T nk 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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