North CooleemeeDAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK PERMIT Date
),Amer/Occupant
To:
Address ±14'y
Address
Building Contractor ; p
Address
Cal. Manufacturer's Name �� p
�,TL� Address j �zz
No. of lines ��- Width _zzin. Total
length 16 a ft. No. sq.
ft.
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 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 specificatiol
Signed:
Septic TaA Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.
i