5376 Hwy 601NDAVIE JCOUN7Y HEAW DEPARTMENT SEPTIC TANK P,ERRMMIT Date 12--2-0-4
Jwner/Occupant To: �` L
Address .S i" Address alk l a,,/
Building Contractor I --Address c -
Cal. r Manufacturer's Name ItA <<21 ddress 26lc� �
No. of lines Width ,34� in. ,Total length 4rp ft. No. sq. ft
Type of filter material - �� Total tons used ,- 9— .� �s'
400
Minimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 600
Two-bedroom house 800
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 specification
Signed: -
Septic Tank Vontractor
Note: Male sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.