P83172 Jericho Church RdJad-x�,�
DAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK PERMIT Date
„3
)timer/Occupant
To:
ad��' vc'lo�Merl4 r F
Address 7,d
Address
Building Contractor �(�rr�wicQ o
Address��
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Cal. ajpp Manufacturer''ssName
Address
No. of lines �, Width in. Total
length a p® ft. No. sq.
ft. 46,68
Type of filter material
Total tons used
340
Minimum REquirements: House Trai er 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 instal ,dZc -to specification
Signed:
Sept c nk Contra for
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.