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DAVIE COUNTY HEALTH DEPARTMENT
Jwner/OccupantA
Address _R 4, ;f—
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Building Contractor
SEPTIC TANK PERMIT Date
To:
Address
Address
Gal. Manufacturer's Name Address
No. of lines Width in. Total length ft. No. sq. ft.
Type of filter material Total tons used
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 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:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.