236 Knoll Crest Rd (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms . Date a
This permit is granted to for the installati of sept'c taAk
at the residence oft/is' r Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 99->0
Manufacturer's Name Qt.�-�Q
i Address
No of lines^ width in. Tot ength /3 ft. No. of Sq. Ft. 02 -
Type of filter material Total tons used �a
Minimum Requirements: House T iter Tank Cap. 800 Sq. ft. -line x+00
Two --bedroom house 00
Three-bedroom house 900 900
No one shall install a septic tank in Davie
Officer or his agent.
Date of final approval
County without a permit from the Health
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed: A5e�
r-�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.