P81272 Bermuda Run.2. Z..-
DAUIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
)timer/Occupant i' • _ To: ,� / �* y ��� n I.'c ,%rz rI f.; Ca .
Address2,-0-,7
f C Address .?' , I7i;Z G �C
Building Contractor Address
Cal. 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 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.