P8873 La QuintaDAVIE COUNTY HEALTH DEPARTMENT
Owner/Occupant
SEPTIC TANK PERMIT Date
To:
Address Address
Building Contractor Address
Gal. d v Manufacturer's Name a ` C fidMess 77,�
No. of lines �_ Width, -,3 4 in. Total length o ft. No. sq. ft.
Type of filter material Total tons used 07
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 Offi(
or his agent.
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specificatioi
Signed:
_,a,,'
SeptTank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.