124 Holiday LnC
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms OCLt,�(Qr'&mN a�X4��� Date )D
This permit is granted to for the installation of a septic tank
at the residence ofC ons an AddressJgcc,
Building Contractor Address T
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name �� AddresslLq-�- z --
No of lines_ width in. Total Length IS"b ft. No. of Sq. Ft. Q?T
Type of filter material Total tons used (V-46
A
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 in alled accordin to
specifications.
Signed:
41) A AIA
Peptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.