323 Powell RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date /a
Jtimer/Occupant (!��,d flze `- To: � ,
11
Address l s!L Address �/S 7/
Building Contr c rAddress
Cal. p O Manufacturer's Name Address
No. of lines _C;7,_ Width 'Yein. Total length , a,� ft. No. sq. ft. �—
Type of filter material Total tons used ,;2
Minimum REquirements: House Trailer ank cap. 800 Sq. ft. line 400
Two-bedroom house 800
Three-bedroom house 900 PS\
No one shall install a septic tank in Davie County without a permit from the Health Offic
or his agent.
Sanitarian
Date of Final Approval
Signed:
I hereby certify that the above septic tank has been installed according to specification
Signed: Q - Q_�
Sep 1 T _ontra V10.r
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.