188 Legion Hut RdDAVIE-�COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date / rl✓1,6a
Jwner/Occupant �-1 o�� e To: f�Roik, ,
Address 4
Address
Building Contractor 14 o [ It s -vi{ /��' v� Address �Ao e res "'Ile,,s✓�
Cal. 0 Manufacturer's Name �(A-v; E_ % % /lA/4Address 'j1' -w e
No. of Lines �_ WidthA—in. Total length Z 5� ft. No. sq. ft. o
Type of filter material Cze-jr, -5-7' ajrr Total tons used 73 3
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 F?ealth Offic
or his agent.
Date of Final Approval
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to spec'ficatior.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.