256 Boxwood Church Rd (3)DAVIE COUNTY HEALTH DEPARTMENT
SEPTIC T NK PERMIT
Date
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Building Contractor
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Cal. , W,) Manufacturer's
Name L/�i%
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No. of lines. -�— Width 3 in. Total length L ft. No. sq. ft. /�Q
Type of filter material Total tons used
Hinimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 400
Two-bedroom house 8006th
Three-bedroom house 1 900 900
No one shall install a septic tank in Davie,County without a permit from the Health Offic
or his agent.
Date of Final Approval %.3` — i Signed:
SatWtarian
I hereby certify that the above septic tank has been installed according to speci/fic�atioo.n
Signed:�rc�.L�-�1��1
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Calolina 27028.
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