P60573 Foster DrDAVIE COUNTY HEALTH DEPARTMENT SEPTIC T K PERMIT Date Ice -5: 7`
JHmer/Occupant 7A. To:A19k 11 '
Address X,. -Address //1� '�
c....
Building Contractor Address
dress
Gal. C� Manufacturer' Name
No. of lines Width 76 in. Total length � � S ft. No, sq. ft.
Type of filter material :h—L 1A Total tons used
inimum REquirements: [louse Trailer Tank cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
T'jye--te room � 00
No one shall install a septic tank in Davie County without a permit from the Health Offic
or his agent.
Date of Final Approval13�Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifica 'or
1
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.
KIM
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