P110872 Davie Academy RdDAIJIE CUNTY HEALTH DEPAR TM -N SEFTIC TANK P RltIT Date
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Jtimer/Occupant °L To:,�}�
Address Z 5 /,;�7' Address
Building Contractor '� J Address
Cal.l�'D Manufacturer's Name ,e Address
No. of lines, Width _t _in. Total length /SZ) ft. No. sq. ft. 4,ncir /
Type of filter materi Total tons used 0
Hinimum REquirements: House T ailer 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'Davre County without a permit from the Health Offic
or his agent.
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Date of Final Approval Signed:
GJ.,e_� /�Zti4fy`_'P;at�he
�,Ti Sanitarian
I hereby above septic tank has been installed according to specificatioT-
Signed: c--(
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.
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