P62073 Deadmon Rd DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date o D
Oumer/Occupant To: ,
Address ;-�:; �4 AddressE41=
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Building Contractor Address
Cal. Manufacturer'same�,��„, C (Z Address q(2�_ /lam
No. of lines Width 4-i—in. Total length 91o2S' ft. No. sq. ft.
Type of filter material gAina, Total tons used 13 OR,
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 accord' g to specification
Signed: C&kz'L I /
Septic ank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
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