P12472 Will Boone RdDAVIE COUNTY HEALTH DEPARTMENT
JHmer/Occupant
Address
Building Contractor p�P /moo
Cal. Manufacturer's Name
SEPTIC TANK PERMIT Date
To:
Address
Address o'grn e -
Address
No. of lines Width in. Total length
Type of filter material Total tons used
Minimum REquirements: House Trailer Tank cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
ft. No. sq. ft.
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 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.