176 Dulin Rd/
DAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK PEWIT Date
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Jwner/Occupant
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Address !�% �2� .
Address
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Building Contractor
Address
Cal. d O ManufacturerIsName
Address
No. of lines Width36 in. Total
length s—D ft. No. sq. ft. S D
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
�91
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 a co in ,to spe ' _.'cation
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.