1266 Hwy 801S (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
i; D, of Bedrooms Date o2 —,? o —6 2
'_:ris permit is granted t ( �)�for the installation of a septic tank.
at. the residence of Address ,,,mac
Building Contractor Address
Septic Tank Specificatiops: Length Width Depth Capacity Gal. F1 _
.Manufacturer's Name Address 4r
«c, of lines_width l6.)in. Total Length JZ) ft. Uo. of q. Ft.
9 -,y -pe of filter material %_y=�7` Total tons used
:Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600,
Three-bedroom house , (900 I- 9061
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: 9 4J �,rs�- s.� _. -�" 4� -IC-e
Septic Tank Contractor
Note: Make sketb of disposal system on back of sheet and mail to Health Center, Mocksville,