362 Wagner RdDAVIE OUNTY HEALTH DEPARTMENT
SEPTI TANK
PEWIIT Date
-
Dimer/Occupant
c
To:
r
,'Address
i C�
Add ss
(
Building Contractors
Address -
Cal.r4anufacturer's Name
Address /�
"�
No. of lines Width -4-1in.
Total
length./ f3N
�,Oft. No. sq. ft.
�r
Type of filter material
Total tons
used
T
Piinimum 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 according to specification
Signed: , r� 'CV., P 4 )
pti.c TaWC6rtffaYtor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.