P111772 PeeblesDAVIE COUNTY HEALT DEPARTMENT
It.--- .
Oi+mer/Occupant
Address . �
Building Contractor
Cal. Manufacturer's Name
SEPTICTANKPERMIT Date
:fes
Address
Address
�C0y�
ess All, �.
No. of
lines / Width ,_3 Lin.` Total length
/ 6-1---)
ft. No. sq. ft. 3 6
Type of
filter material�7i_-:i.L..Total tons
used —
Hinimum
REquirements: }iouse T ailer 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 Offic
or his
agent.
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specification.
Signed:%!
�
peptic Tay Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.