4944 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PEW4IT Date
Jwner/Occupant (!f_i10 / % To:
Address � V % Address
Building Contractor Address
Cal. -c-- Manufacturer's Name Address... eJ
No. of lines �� Widthin. Total ength / ?.S— ft. No. sq. ft.
Type of filter material --L� Total tons used
Minimum REquirements: }louse 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 inst;&accor in to specification
Signed:
S ptic 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.