215 Parker Rd (2) DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date —
Jwner/Occupant To:
t pa v �
Address /�� , 7, /t/� f Address
Building Contractor Address
Cal. Manufacturer's Name " Address./?'/, 3
No. of lines I Width ,�in. Total length Ij-S' ft. No. sq. ft. 9,),s
Type of filter material -A2°10 Total tons used
Minimum REquirements: orail r Tank cap. 800 Sq. ft. line 400
qwo--Ndroom 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 Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.