225 Bingham & Parks Rd1�
�s v
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms p? Date p?
This permit is granted toa"01, S-14(-3 for the insta 1 n of a se is tank
at the residence of E -r ✓ c'K ,�/sa n Address - W
Building Contractor �ti Address
Septic Tank Specifications: Length Width Depth Capacity Gal.'dZ�
Manufacturer's Name Address
No of lines o _ width in Total Length ft. No.. of Sq. Ft. G
Type of filter material Total tons used 7b -'-j7
Minimum Requirements: House Tr er 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: '
ptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.