2554 Hwy 158 (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
�.; of Bedrooms Z Date .5 -/3
'7his permit is granted to 11Z ,7 ; (A , for the installation of a septic tank_
.it the residence ofYt�v, IF �rfo�c"� Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. q a o
Manufacturer's Name Address / 41 ,, % "k s 7-o
No. of lines C_width 3,/- in. Total Length loo ft. Xo. of Sq. Ft. 6 a a
i' rpe of filter material � Total tons used
Minim= Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
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
Ihereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sket h- of disposal system on back of sheet and mail to Health Center, Mocksv'1 e.
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