P72373 Wood Valley Lot 116-By4 Q
DAVIE COUNTY HEALTH DEPART NT EPTIC TANK PERMIT Date
)timer/Occupant To:
Address '�/�
yq,rc Address ,� /// �%-,, (5 -
Building Contractor M//70 Address
Cal. 0 0 Manufacturer's Name � 6 Address N, C
No. of lines �_ R'idthin. Total length /,3 3 ft. No. sq. ft. a o
Type of filter material Total tons used r? X
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 specificatioi
Signed: '
Se is 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.