201 N Pino Rd (2)DAVIE COUNTY HEALTH DEPARV-1ENT SEPTIC TANK PERMIT
No of Bedrooms -7)'Y# : '�Y, Date /II—/ ems' )l
This permit is grante to for the ins allation of a septic tank
at the residence of r Address , ai 2 C
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 91010
Manufacturer's Name Address
No of lines_ 3 width_ 361 Total Length ft. No. of Sq. Ft. ROO
Type of filter material/D 7� Total tons used ♦!o D
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. &�� &eKe-
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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