207 Midway StDAVIE COUNTY HEALTH DEPARTPIENT SEPTIC TANK PERMIT
No of Bedrooms "3 Date 2-a ? -6 5
This permit is granted to _ 9.T, �,. for the installation of a septic tank
at the residence of ,C_ e- yo ),t Address 6
Building Contractor h44 Vr`X Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 2DO
Manufacturer's Name l�Cr „fes? r Address
No of lines _ width_j6 in. Total Length L5 ft. No. of Sq. Ft.
Type of filter material ��- Total tons used 'e_
Minimum Requirements: House Trai r Tank Cap. 800 Sq. ft. line 1+00
Two--bedro m 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.