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.DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
7.0. of Bedrooms Date
:'.his permit is granted to for the installation o`f� a septic tank._
.t the residence of Address-�,�3e�wZC
Building Contractor 1� Address
Septic Tank Specifications: Length Width Depth Capacity Gal. q00
MEmufacturer's Name 'T., . Address
No, of lines_ $ width in. Total Length ft. No. of Sq. Ft.
T.Te of filter material Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line I+00
Two-bedroom house S<::6-
0jb
Three-bedroom house X900 900
No one shall install a septic tank in 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 ecifications.
Signed:
Septic Tank Contractor
Mote: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville.