196 Latham Farm Rd (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTI TANK PERMIT Date
Jc+mer/Occu an ' To :
Address , Address ,�=��C
Building Contractor Address
�_ Manufacturer's Name Address
Cal. — �--
No. of lines _ Z Width .3 in. Tot length _ft. No. sq. ft.
Type of filter material J r �i Total tons used
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 Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specification
Signed
ti Ta oritrac
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.