1624 County Home RdDAVIE COUNTY HEALTH DEPARTMENT
Owner/occupant
Address r/IX0 .t da k -w 40 r_ I!; o,
Building Contractor
SEPTIC TANK PERMIT Date
To: r-rfzt u
Address
Address
Cal. manufacturer's Name .IQ q - Address
oto. of lines Z_ Width _3 �, in. Total length ft. No. sq. ft./
Type of filter material Total tons used Z (e
Hinimum REquirements: house Trail 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 o spec'f " atior
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.