P4573 Riverview Rdl rs
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PEWIT Date
Jvmer/OccupantyrS _ To:� % (�° r
Address aay 01 Address %
Building Contractor �— Address
Cal5�0 Manufacturer's Name s �,;� �,� ,� Address
No. of lines _ Z Width JK n—. - Total length � fa D ft. No. sq. ft.
Type of filter material ��— Total tons used /a?
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: 12 4
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.