P8272 Liberty Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
JHmer/Occupant ` ��,r' To: ,/ t� k.%1, es
Address S� /, , ��,o _ '—
,� Address , S , c i , r• ,,�
Building Contractor �r�t c,,`en �79S�s <� t Address �� n rr (acks>
Cal. 1,90 o Manufacturer's Name �� �_ Address
No. of lines _�� Width egllin. Total length ft. No, sq. ft.
Type of filter material
Total tons used
Minimum REquirements: House 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 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.