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DAVIE COUNTY HEALTH DEPART1114ENT SEPTIC TANK PERMIT
No of Bedrooms 3 Date / — _-2- /— 7 /
This permit is granted to U( t�7/4"s for the installation of a septic tank
at the residence of �A,��/ Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 9a a
Manufacturer's Name Address
No of lines y_ width . 36 i_n. Total Length , ?o z.ft . No. of Sq. Ft. �1 a
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.
Septic Tanuontr`aAor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.