P121972 Cana RdDAVIE COUNTY HEALTH DEPART -NT
Jcmer/Occupant
Addressi {�toor
SEPT4TNKEWIT Date 1 2--
To:
--To:
Address Ste%
Building Contractor Address
Cal.g� Manufacturer's Name
L=C�°
No. of lines �_ Width 36 in. Total length �,3�""— ft. No. s q• ft
Type of filter material Total tons used %S
Minimum REquirements: House T ilea Tank cap. 800 Sq. ft. line 400
600
Two-bedroom house 800
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Date of Final Approval
Signed:
Sanitarian
I hereby certify that the above septic tank has been install Id acco chino specificatior
t
Signed:`" ,
Sep is an contractor
Note: Make sketch of disposal system on back of sheet and mail to Davie County Healt
Center, Box 57, Mocksville, North Carolina 27028.