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889 Williams Rd0 di , foo DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PEWIT Date to ) mer/Occupant � �dc� r- t�'�� /'S To: Address ��, r� _✓4 k Address Building Contractor j,a2_ Address c Cal. �O Manufacturer ' s Name, �, lij�s ucc! t l "j , �p , Address No. of lines ,_ Width __)Sin. Total length i p ft. No. sq. ft. -j< o7 d Type of filter materialTotal tons used f �C Minimum REquirements: House Traile/� 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 Offii or his agent. Date of Final Approval Signed: Sanitarian I hereby certify that the above septic tank has been installed according to specification Signed: �,©-��r----- Septic ank Contydctor Note: Make sketch of disposal system on back of sheet and mail to Davie County Health Center, Box 57, Mocksville, North Carolina 27028.