P11972 Ben Anderson RdCJ "�!
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PEWIT Date _� \
Jwner/Occupant &On f f` To: J i�. r t� Q k *2,S
Address T� c�< • / [ ( Address �
Building ContractorAddress
Cal. ¢J Ci Manufacturer's Name ! � Address � "4 � & J1
Vo. of lines �_ Widthn. Total length j ZQD ft. No. sq. £t.__/ e
1 B
Type of filter material Total tons used Z.3
Minimum REquirements: House Tr ler 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 specificatiox
Signed:
jP4tT4aV9ftrac
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box S7, Mocksville, North Carolina 27028.