P10973 W L WalkerDAVI5CCOUNTY HEALTH DEPARTMENT
Owner/OccupantP"i� ' 4' A,, Y
Addressj�� i 4
Building Contractor
Cal. Manufacturer's Name
No. of lines Width in.
Type of filter material
SEPTIC TANK PERAIT
To:
Address
Address
Address
Date�2-c;_ .�
Total length ft. No. sq. ft.
Total tons used
Minimum REquirements: douse 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 Offi(
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.