P71273 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
Ji,Tner/Occupant To:
Address Ia Address FX
Building C ntractorAddress
Cal. / Manufacturer's Name �� Add ess` p� F
No. of lines Width _,j.(e_in. Total length moo ft. No. sq. ft.
Type of filter material p c� Total tons used .3 i9N
Hinimum 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:Offi(
or his agent.
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specification
Signed: AL� Y_Aj_A,�k
TTTr Z)eptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Sox 57, Mocksville, North Carolina 27028.
"I,
�as��