P101672DAVIE COUNTY HEALTH DEPARTMENT SEPT TANK PERMIT Date � c 44-, 7 --
Jwner/Occupant To:
Address _ Adress en la'��f
Building Contractor 9/9 6Q ct (E' Address
Gal. 900 Manufacturer's Name �c��-- Address
No. of lines ��_ Width 4in. Total length Sr ft. No. sq. ft.
Type of filter material p�2 Total tons used C;7,6
,$'�
Minimum REquirements: House Trail Tank cap. 800 Sq. ft. Zine 400
Twoe bedroom house 800 600_
Three-bedroom house
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
Ithereby certify that the above septic tank has been installed according to specification
Signed:
&pt'c a ntract
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.