997 Howardtown Circle (2) DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PEW-1IT Date
Owner/Occupant To: Q` ,j
Address� Address /�a
Building Contractor � �(� � 2/��_ Address
Cal, Ypb Manufacturer's Name Address
No. of lines a Width (P in. Total length Zj ft. No. sq. ft. je as K /
Type of filter material Total tons usedD—3
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:
Septic Tanf tontractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box S71, Mocksville, North Carolina 27028.
V.