1731 Fork Bixby Rd (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT— Date —,3 — 93
Jwner/Occupant Y- _ c7) Scl7� C
rvt zC�' To: �
Addressr 2,v 4 c« Address P7� ¢; / !Y J 4,
Building Contractor �� �.�' Address
Cal. !9m Manufacturer I s Name � � �%l�l Address
No. of lines `�_ Width in. Total length t o a ft. No. sq. ft. :Co-o
Type of filter material —J Total tons used Com`
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 specificatioT
Signed: 4�?eoe �*-
Septic Ttnk Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.