P92673 Daniel RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC
//TANK PERMIT Date
Owner/Occupant �i(�� IS To:
Address
Building Contractor '<<� Address
Gal. 0 Manufacturer's Name �jQ ,�, j, Address —/
No. of lines �� Width .�_ezin. Total lengthy ft. No. sq. ft.
Type of filter material Total tons used a% e
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 installed a cordin o s ecif'catiox
Signed:
/Sdptic Tahr Contfor
'yV
Note: Make sketch of disposal system on back of sheet and mail to Davie County Health
Center, Box 57, Mocksville, North Carolina 27028.