4126 Hwy 158DAVIE COUNTY HEALTH DEPARn-IENT
SEPTIC TANK PERMIT
No of Bedrooms Date7)/9�%
This permit is granted to for the installation of a septic tank
at the Address 14
Building Contractorp� Y-ZX1q`7�(e&4 Address
Septic Tank Specifications: Length Width Depth Capacity Gal. � o�
Manufacturer's Name Address
No of lines, width 364. Total Length ft. No. of q. F . po
Type of filter material Total tons used eZ D
Minimum Requirements: House•Trailor Tank Cap. 800 Sq. ft. line 400
Two --bedroom hous r.' 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.