157 Fireside LntA�
DAVIE COUNTY HEALTH DEPARTMENT
Owner/Occupant (��az
Address
Building Contractor
SEPTIC TANK PERMIT Date I' 3
To : o`.
Address
AAArPcc
Gal.Manufacturer's Name Address
jo. of lines (_Width _&Lin. Tota length /� S� ft. No. sq, ft.
Type of
filter material
Total tons
used /
Minimum
REquirements:
House Trailer Tank
cap. 800
Sq. ft. line
400
600
Two-bedroom house
800
600
Three-bedroom house
900
No one
shall install a
septic tank in Davie
County without
a permit from the
Health Offi;
or his
agent.
Date of Final Approval
I hereby certify that the above septic tank has
Signed:
Sanitarian
been instal acco 'n t ecificatio,
Signed:
Sept.c ank Cont actor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27.028.