1651 Hwy 801S-- -'-_-__.-_.-
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DAVIE COU TY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date ; 9 2
Owner/Occupant 40n 7e s To: CY-i^G
Address Al, C : Address
Building Contractor %�, �, �-e Address W,`n,f iia_/C
Cal. 9&P Manufacturer's Names�� pq� .S, j ,, �� , Address All- �X� 4
No. of lines �_ Width -j-4 in. Total length 200 ft. No. sq. ft. DD 1114,,e
Type of filter material d r ,740 i7e Total tons used
Minimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 .00
No one shall install a septic tank in Davie County without a permit from the Health Offic
or his agent.
Date of Final Approval /v;?--- Signed:
�thitarian
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.