P72572 Edwards - Harmonya J)
.1*11° I'J
/91"2
DAVIE COUNTY HEALTH ``DEPARTMENT SEPTIC TANK PERMIT Date 2 S
JHmer/Occupant %a<fS�Nr �Qic�ci r�3 To:
Address n _ Address Z
Building Contractor e—Address
Cal. --f =j Manufacturer's Name ���n��• Address ,SS7trt 74e.s'v��_
No. of lines Width _�(Zin. Total length a 3 Sft. No. sq. £t. 2 O
Type of filter material ��'��' /� Total tons used f -I �T 3.le,
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 accojr�ding to specification
_ 11
�S_7C471fe,s� e / Signed:,���---r �.�
ll, � � !� � 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.