P101873 St Matthews RdDAVIE COUNTY HEALTH DEPARTb •NT
SEPTIC TANK
PEW,1IT Date
l
)kmer/Occupant 1iL ' > _
To
Address �, /
Address
/ Ze
Building Contractor
Address
Cal. HanufacturerIs Name 7�A-`
Address
T A4.
^96V-
No. of lines % Width Lzin. Total length
_/S ?> ft. No. sq.
ft. 6 v�
Type of filter material T-
Total tons
used a �j
Minimum 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 inst
d accordink
to s ecificatio?
Signed.
Septi k Con r c r
Note: Make sketch of disposal system on back of sheet and
mail to Davie
County Health
Center, Box 57, Mocksville, North Carolina 27028.
s sr