231 Cana RdDAVIE COUNTY HEALTH DEPARTPIENT SEPTIC TANK PERMIT
No of Bedrooms _ Date tl `Cry r _ 19 -7 a
This permit is granted to Q,�t' �� for the installation of a s ptic tank
at the residence of �I , C Address (?
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.�-
Manufacturer's Name Address �s �Cz•/Lt�-,
No of lines,_ tiridth,_� in. Total Length 1 -3SLft. No. of Sq. Ft.
Type of filter materiaTotal tons used
Minimum Requirements: House Tradipr Tank Cap. 800 Sq. ft. line1+0
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: � i' • ayt,
Septic Ta& Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.