142 Eric Rd (2)0
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date 3- -,)zz
Jwner/Occupant j` reern4K r/rQ c- To:
Address "l'••2 }
Address
Building Contractor �ru,�! Address
Gal. eg,> Manufacturer's Name _ Address
No. of lines Width��in. Total length _j c2� j ft. No. sq. ft.
Type of filter material ;�t1 �r�•r � Total tons used 3
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
or his agent.
Date of Final Approval Signed: 4
Sanitarian 7
I hereby certify that the above septic tank has been installed a cording,to specificatioi
Signed: 1,;144
Se tic Tartk C6rrlctor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.