223 Turrentine Church RdDAVIE COUNTY HEALTH DEPARTMENT
Jwner/Occupant.,_
SEPTIC TANK PERMIT Date — !o
To:
Address Address
Building Contractor Address
Cal. ► Manufacturer's Name Address
No, of lines width in. Total length
ft. No, sq. ft.
Type of filter material Total tons used
Hinimum REquirements: House Trailer Tank cap. 800 Sq.
Two-bedroom house 800
Three-bedroom house 900
ft. line40
600
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:
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.