224 Seaford Rd (3) jeal,a� fz .
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
Bio, of Bedrooms Date
11is permit is granted to for the installation ofa septic tank
at the residence of Address { 6
Building Contractor Address _
Septic Tank Specification/s: Length Width Depth - Capacity _Gal. 24m
Manufacturer's Name c�� 7'i�° Address �.�.
No. of lines_,,:,7,yidthZin. Total Length _ft. X70. of Sq. Ft. av
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
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 been installed according to specifications.
Signed: �, T�L,
Septic Tank Contractor
. Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville,
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