P101673 Hwy 801SDAVIE COUNTY HEALTH DEP�AQRT�MENT
SEPTICC THANK PERP-tIT Date
Jwner/Occupant j,� G�
To: 1� L�
_
Address 6; 6'� Address
Building Contractor
Address
Cal. !2fO Manufacturer's Name l�u.�w`�1�i�,
Address
No. of lines �� Width �in. Total
length —ft. No. sq. ft. o O
Type of filter material S
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: 170d�
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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