P50473 Hwy 64 WDAVIE COUNTY HEALTH DEPARTMENT
Jumer/Occupant I 1),3
Address o f
Building Contractor
Cal. Manufacturer's Name
SEPTIC TANK PEWIT Date S- #-- 93
To:
Address
Address
No. of lines Width yin. Total length
Address
ft. No. sq. ft.
Type of filter material Total tons used
Minimum REquirements: house Trailer Tank cap. 8 0 Sq. ft. line
Two-bedroom house 800
Three-bedroom house 900.
GO
600
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:
Septic Tank Contractor
Note: Make sketch of disposal system on back df sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
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