4897 Hwy 158-k�2144u SiS �;VIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK PERMIT
of Bedrooms
/
Date
.*o, _
:'.:his permit is granted to ��
for the of a septic tank
at the residence of Ac l h1 �!^ � ''•L _
,installation
a Address
Building Contractor /�WA4,,�Jt- 7-111 � !
Address
Septic: T( nr Specifications: Length Width__
Depth Capacity Gal.
Mz,aiufacturer's Name
Address
No., of lineswidth in. Total Length /S�0
ft. No. of Sq. Ft. l ao
Co e of filter material
Total tons used
T,Y"Lalm1,.a 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 i.is a ent'
;rte 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 sketb'-!, of disposal system on back of sheet and mail to Health Center, Mocksville,