261 Martin Luther King Jr Rd'V u -��
DAVIE COUNTY HEALTH DEPARTMENT
Jtimer/Occupant Vt
Address 7;()Rc�c �
Building Contractor
Cal. Manufacturer's Name
No. of lines
SEPTIC TANK PERMIT
To:
Address Address
Address
Width in. Total length
Date 5' -
Address
ft. No. sq. ft.
Type of filter material Total tons used
Hinimum 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.