2360 US Hwy 64 W Lot 4DAVIE COUNTY HEALTH DEPA TVIIENT SEPTI PERMIT
No of Bedrooms 3 a�
This permit is granted to � < for the installation
ion of a septic t6
at the residence of Address
Building Contractor -,Address k --I-' f
Septic Tank Specifications: Length_ Width Depth apacity_ Gal._
Manufacturer's Name Address;5/- 99Zoa� fGGE�i�
No of lines / width
J�jv 'in. Total Length 223 ft." No. of. Sq. Ft. foo
Type of filter material /o'Af S1�?/�✓� Total tons used uo y o
Minimum Requirements: 'House Trailer Tank Cap. 800 Sq. ft.;line 400
Two-bedroom house. 800 600
Three-bedroom house 90 90
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: 2�
eptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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