1484 Hwy 64W (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date
Owner/Occupant
r_7 _r /�%g c u a� w_ To
Address Adcess
Building Contractor ��r„� _ Address
Cal. Manufacturer's Name <: Address
No. of lines / Width -7 in. Total length 9L5 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
y
v
3' 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
Signe .
e. is IrContta-ZVor
Note: Make sketch of disposal system on back of sheet an mail toie County Health
Center, Box 57, Mocksville, North Carolina 27028.