P62873 Deadmon Rd DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date — —
Jwner/Occupant To:
Address _ Address
Building Contractor Address .! L�� � �
Cal. Manufacturer's Name / Address
No. of lines , Width - in. Total length CM Sft. No. sq. ft. 9 d c�,
Type of filter material Total tons used 3,0
r
*Minimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 00 X00
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: 0 yaj e� el
Septic TaiTk Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
___ - �r c'�� o�v Of e,�d