292 Gun Club Rd (2)DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT /
Uo. of Bedrooms v7 Date / a -
:his permit is granted to for the installation of a septic tank..
at the residence of a-< Address 1 7-, c
Building Contractor Address
Septic Tank Specification Length Width Depth CCapaacity, Gal. .2.D.0
Manufacturer's Name Address
No. of lines width in. Total Length 3,9D ft. No. of/Sq. FZ1e' o
Type of filter material Total tons used �� O
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
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 acc�cording to specifications.
Signed: 04 r�4 r--=. 6 -; -
Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.