1003 Sheffield Rd (2)DAVIE
Owner/Occupant
Addressa_4z�
Building Contractor
Cal.
No, of lines
HEALTN DEPARTMENT SEPTIC TANK PERMIT Date
T o : i
• Address
01
Address
's Name �_ Address r
+Z Width Y in. Total length d�25� ft. No. sq. £t. 9oD
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.