554 Children's Home Rd (2)DAVIE COUNTY HEALTH DEPART12ENT SEPTIC TANK PERMIT
No of Bedrooms C5� _ Dates / V,
This permit is granted to for the installation of a septic tank
at the residence of J , c—i ` s 4Address P7,, 57 l.� Ir
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 9 fb
Manufacturer's Name Address
No of lines_L width,-2�Tin. Total Length ,LS ft. No. of, Sq. Ft. a a
Type of filter material _ _ 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.