583 Foster Dairy RdDA`JIE COUNTY HEALTH DEPARV-1ENT SEPTIC TANK PERMIT
No of Bedrooms oZ Date -i -z- —G
This permit is granted to _ usb-k l"s for the install tion o a se tic tank
at the residence of �'r4k, � s� H e,S Address ,N"�
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. `7 oc>
Manufacturer's Name Address
No of lines_ width i . Total Length 120ft. No. of q. Ft. f'o-O
Type of filter material Ar-7,ro � 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.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.