P113073 Wood Valley Lot 101Z-� 4�7` r a i•
DAVIE COUNTY HEALTH DEPARTMENT
DHmer/Occupant
Address. T'���� 14
K.
Building Contractor
SEPTIC TANK PERMIT Date
To: Q�
Address
-- Address
Cal. Manufacturer's Name Address
No, of lines �_ Width in. Total length S ft. No. sq. ft. 2_2�
Type of filter material Total tons used KCX
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 install acco ing pecificatior
Signed:
ep isTank' ntractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
IV 7i
Ivy