169 Granada Drive Lot 60-B& q (rMNA
DAVIE CO TY L'EALTH DEPARTMENT
Sumer/Occupant (p 6-6
Address
SEPTIC.T K PERMI Da /G, 7�(�
To: < e
Ad ess
Building Contractor Address
Cal. Manufacturer's Name Address `
No. of lines Width _3 (min. Total length ��? _ o. sq. Z
Type of filter material s Total tons used 7 `l
Hinimum REquirements: douse 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: /(�J
Sdolitarian
I hereby certify that the above septic tank has been insta ed according tecificatioi
Signed: 0tet.
Septil Tank Contr ctor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.