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DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No 02 % ra : re r�S /Q if DateThis permit is granted to for the installation of a septic tank
at the �___�___ _i' rr`T'�. j,w s le r Kor ,,Address '/% C,ree �r 1�d r
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.L2�
Manufacturer's Name Address�JQ�,�
No of lines a width -(k n. Total Length ft. No. of Sq. Ft. U'aJ
Type of filter material �_r Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. t ne 400
Two-bedroom house 800 600
Three-bedroom house 900 goo
No one shall install a septic tank ifs Davie County without a permit from the Health
Officer or his agent.
Date of final approval Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed: d� C✓. 'Lfix C '-:f_
i Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.