P102772 EvansDAVIE COUNTY HEALTH DEPARTMENT
DHmer/Occupantkz,
Address
SEPTIC TANK PERMIT Date)-2--
To:
Z
To: ,(j i
Address
Building Contractor Address
Cal. d)Manufacturer's Name Address Address
No. of lines �, Width in. Total length j,�rp ft. No. sq. ft. �/J_i>
Type of filter material Total tons used
Minimum REquirements: house railer 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 Fealth 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: I
�e T ontra r
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.