P100973 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERI'-lIT Date
Owner/Occupant 1,-<-/=(l•r ;%%, ,4„ rd To:
AddressA,4
r cV j �' �1 f, t j Address
Building Contractor .�,,�H %, Address
Gal. Manufacturer's Name Address
No. of lines Width in. Total length ft. No. sq. ft.
Type of filter material Total tons used
Minimum REquirements: House Trailer Tank cap. 118-0-0-1 Sq. ft. line
Two-bedroom house
Three-bedroom house 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 specification
Signed:
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.