253-261 Martin Luther King Jr RdC
i
v - -�
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date !7Z g
Jkmer/Occupant/)-'� :z ,.�szi To: f
Address & /-2_-, Address ! p-•
Building Contractor r Address s
f`
Cal. Manufacturer'�Name Address-,
No. of lines �_ width38 - Yin. Total length �S'- 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
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
Signed:
Septic 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.