P71472 LowDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date 5 y—
Jwner/Occupant�Iwbck2
(Z pUj To:
Address �( c_ Address
Building Contractor Q m e Address
Cal. Manufacturer's Name, v�` o .,, Address¢�c_ jt,s F
No. of lines .Width J�in. Total length_ O ft. No. sq. ft.
Type of filter material �u,t� Total tons used
Minimum REquirements: House Tr filer 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 specificatior
Signed VA'LJ`
ept c Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box S7, Mocksville, North Carolina 27028.