158 Center Circle Lot 26DAUIE OUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date .3 •/`/�— %OZ
Owner/Occupant e'r c, O11k 1✓l'r To: -T-)QAv-p
Address
r yl CMCJ. Address 4r
Building Contractor ` < Address
Cal. 2e Manufacturer's Name ` ` Address
No. of lines �_ Width �n. Total length ,7�ft. No. sq. ft. Do Lg
Type of filter material o Total tons used O
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 tf.►�,2 Signed: /
itarian
I hereby certify that the above septic tank has been installed according to specification
Signed: 72e;lel e0^1
Septic Tabk Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
rr