P11273 Wood Valley Lot 83-BAWW_ 8r3 0
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Dateaal
Jumer/Occupant To:
Address � f v n c Address S�
Building Contractors Address
Cal. p Manufacturer's Name Address
.No. of lines _:Width in. Total length 13 S'-- ft. No. sq. ft. lo S 1
Type of filter material Total tons usedcZo
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 Offir
or his agent.
Date of Final Approval
Signed:
Sanitarian
I hereby certify that the above septic tank has been instal d accordin specification
Signed:
Se tic Tank C ntractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.