P51272 Sheffield ParkDAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK PERMIT Date
/aq /07.i9 7Z
JHmer/Occupant' _
To: 6rqg Ao m off a X'o y
S"
Address 65460�{1N/d/Rrj�4 Noc/c-s.
Address
Building Contractor'L_)jcf(%e84jl¢fM4do -
Address e.'
Cal. Op Manufacturer's Name
Address
No. of lines Width in. Total length
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 specificatigx
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.
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