191 Shoffner Rd��os
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date /a - � r�
Jhmer/Occupant f -CAD -11 2Ke C_ To: J, Uj
Address /Yn�� Address
Building Contractor Address
Cal. - - Manufacturer's Name Address 3 o�-t :+�Z-7
No. of lines _�_ Width �in. Total length A D ft. No, sq. ft. , oo
Type of filter material p r Total tons used I
Minimum REquirements: House Trailer Tank can. 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
Ihereby certify that the above septic tank has been -installed according to specification
Signed: f
OleptU-Ta r Atracto
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.