P41868 BrackensDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
Sao, of Bedrooms /A.a� D Date
`suis permit is granted to llse� for the installation of a septic tanb; .
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at the residence of — Address / , j ,, oWiLcu�
Duildir.I Contractor Address
Septic Tann Specifications: Length Width Depth Ca acity Gal. e) 0
14anufacturer's Name Address_ _
I?o; of lines---L-Width in. Total Length ft. No. of Sq. Ft.
TvDe of filter material Total tons used
irini:a,=.n Requirements: House Traile Tank Cap. 00 Sq. ft. line
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 Officer
or his agent.
Tate of final approval Signed:
Sanitarian
I hereby- certify that the above septic tank has been installed according to specifications.
Signed: _
Sept c Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville,
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