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604 Ralph Ratledge Rd
J -1 �� DAVIE COUNTY HEALTH DEPARTMENT SEPTIC T KIK PERMIT Date d O /� �� OHmer/Occupantl � rr C9ro y /- To: r w Address �{:Y' 1,4L Address , p7 Building Contractor;ynz - Address Cal. p© Manufacturerts Name Address No, of lines �_ Width -4_6n.Tolength �? S� ft. No. sq. ft. OD Type of filter materials Total tons used �Q Minimum REquirements: House Trai er 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: A4:f-)4 Septic Tank Contractor Note: Make sketch of disposal system on back of sheet and mail to Davie County Health i� Center, Box 57, Mocksville, North Carolina 27028.