P92172 HutchensDAVIE COUNTY HEALTH DEPARTMENT
Owner/Occupant J4! SSS
Address ,
Building Contractor
SEPTIC TANK PEWIT Date o2/ -t_
To:
Address
Address
Cal. Manufacturer's Name
No. of lines Width in. Total length
Address
ft. No. sq. ft.
Type of filter material Total tons used
Hinimum-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.
Elct&e