4962 Hwy 158 (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms 1,"� (e r- f'z;1 r ��0`" Date / �... � 7 O
This permit is grant9d to ec or the install tion of
Address
s ptic tank
'T
at the residence o 4
at
Building Contractor Address
Septic Tank Specifications: /4L/dWidth --5 Depth 6, Capacity
Gal. l� d
�Length
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1
Manufacturer's Name Address��-
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No of lines ! width_ in. Total Length 1410 ft. No. of Sq. Ft.
Type of filter material.LLxz % d Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft.
line �+0
Two --bedroom house. 800
00
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.) L
Signed:
eptic Tank ontractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.