P71273 Bear Creek Church RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC K PERMIT Date
OyAmer/Occupant To:
Address'24� d2' 6 Address
r
Building Contractor Address
Address
Cal. Manufacturer? Manufacturer's Name C'4 Address -
No. of lines `�_ Width &Zin. Total length ft. No. sq. ft. l3O
Type of filter material Total tons used 3,0
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 ank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.