4359 Hwy 64W (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date — / Q — 9/
This permit is granted to for the installation f a.'s ptic tank
at the residence of Address , /, �`
Building Contractor Address
Septic Tank Specifi tions: Length Width Depth Capacity Gal.
Septic Tank Specifi?tions.:
Manufacturer's Name D Address
No of lines 7 vtidth41in. Total Length Das ft. No. of Sq. Ft. i a o
Type of filter material Total tons used d ci 36
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: � �Aa4-,7�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.