P72672 Wallr--
DAVIE COUNTY HEALTH
DEPARTMENT SEPTIC TANK PERMIT Date ilt cz
Jumer/Occupant a 1W�---- _ To:
Address1 % vc` iC'
Address41
Building Contractor Address
Cal. DO Manufacturer's Name L Address , 3 .�-
No. of lines �_ Width /2pin. Total length c�D ft. No. sq. ft. G7 DD
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 aseptic 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:
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.