134 Holman StDAVIE COUNTY HEALTH DEPARTMENT SEPTIC ANK PERMIT Date/�-
Ovmer/Occupant ` To: �� )J-1216,14)
Address r `�` _ Address Z
Building Contractor _ Address
Cal. %ate Manufacturer's Name Z2-74 - Address
No. of lines Z Width ��n. Total qength � S� ft. No. sq. ft.
Type of filter material Total tons used !
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 Health Offic
or his agent.
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specificatioi-
c �
Signed: �f r,�� .� ,w_.1(
.- 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.