2044 Cana Rd (3)�?S
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date)—,?--u
Jamer/Occupant Y-0 _r 4 /j ��q m _ To: ��„ ,�, G", e -
Address 00 C /CS I,, Ile ea <L Address
Building Contractor 7� �` Address
Cal. 178�0 Manufacturer's Name ��� �,�� � � Address
No. of lines ^�_ Width 3,1_ in. Total length /35 ft. No. sq. ft. 4465'
Type of filter material /o ?f' Z2 --e--•— Total tons used
Hinimum REquirements: House Trailer Tank cap. 800 Sq. ft. line
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 % 2 7_? Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specification
Signed:
Septic T nk Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
11 zi�;f