140 McCullough Rd (2) DAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedrooms.. ' Date
Thisp ermit is granted to for the installation of a s pti� .
at the residence of c" Address ,
Building Contractor _ Address
Septic Tank Specifications: Length Width Depth Capacity Gal 9zm
Manufacturer's Name Address 7 _
No of linesL Vfdt2 in. Total Length 6tec ft. No. of Sq. F ��
Type of filter materialL , ITotal tons used a
Minimum Requirements: Hoose Tref ler Tank Cap. 800 Sq. ft. line 1+00
Two--bedroom house 800 600
Three-bedroom house 900 J 900
No one shall install a septic tank in Davie County without a permit from the Health
Officer or his agent.
Date of final approval Signed:
Sanitarian
I hereby certify that the above septic tank has beenW:f4/-2-/%ed accord g to
specifications.
Signed:
1
J Se tic Xank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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