P51073 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERP,1IT Date fir-
)wner/Occupant To: � ; ij
Address/4Y �R� Address
Building Contractor 361"Q ems_ Address
Cal. ria PIanufacturer's Name' _ Address
No. of lines �_ Width 3�in. Total ength � (o � ft. No. sq. t T4�1��*4F� L�
Type of filter material _ Total tons used
Minimum REquirements: douse 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 accordi to specification
Signed•
e i.c- 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.