P71973 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PEW4IT Date
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D mer/Occupant mac` !1 c , To:
,'Address �p® �P7?P� Address
Building Contractor Address
Gal. 2RD manufacturer Is Name , � �/ ��� Address
'Io. of lines / Width _��in. Total length o?d )_ ft. No. sq. ft. Vg -d
'type of filter material cQ Total tons used
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 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.
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