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P91272 Hwy 601S/4..�-ti -�� DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date Jwner/Occupant.? r© f� 7 enn In,? ; ,, f To: Address C Address Building Contractor c- Address Cal. -�-=- Manufacturer's Name GJ �lu•tZ CY,%'rC�j Address 2EY: No. of lines ,�_ Width in. Total length ft. No. sq. ft. 5�D6 Type of filter material 7r/ o � Total tons used d 9 -3 o Minimum 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 specificatioi Signed: 730 1 � r �'e,,r- 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.