4395 Hwy 64W (3)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
" cce r✓; ,� Q V4 "j�: Q yt Date t- 0 2 -
This permit is granted to ' .G rr,o for the installat of n of a septic tank
at the of 4'ssD D; / C'o, 4 ,•,,, Address -,K Y/
Building Contractor ` 6 7. Address .
Septic Tank Specifications: Length Width Depth Capacity Gal. yo o
Manufacturer's Name Address
No of lines width in. Total Length ft. No. of Sq. Ft.
Type of filter material Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line
Two --bedroom house 800
Three-bedroom house 900
1+00
600
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:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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