107 Hillcrest StDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT Date �-
Owner/OccupantTo:
Address,C1
,.'�� '=�.r7`,� �--- Address
Building Contractor ` Address
Cal. Manufacturer's Name Address
No.� of lines Width in. Total length
ft. No. sq. ft.
Type of filter material Total tons used
Minimum REquirements: House Trailer Tank cap.Sq. ft. line pno
800
Two-bedroom house -6-60P
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without a permit from the Health Offit
or his agent.
Date of Final Approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specificatio:j
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. 1
--�s S