P71772 Benbow=/I
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date r
f
JHmer/Occupant r To: t, -
Address
Address
Building Contractor (7'c Address
Call//,_iTp Manufacturer's Name- Address'
i
No, of lines width `�in. Total length J�ofJ ft. No. sq. ft. oc7
Type of filter material old Total tons used 3
Hinimum REquirements: House Trai er 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 ac ording to sp cificatioT
Signed r �f �v
�E* r ank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.