359 Allen RdDAVI`ECOUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
!o,. of Bedrooms (�a,c.,x:-� Date
his permit is granted to for the installation of a septic tank_
zt the residence of �'� `r•�Gw Address
Bui:'ding Contractor ��n�. L, !� Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
M nufacturer's Name Address
t?o, of lines width in. Total Length ft. Llo. of Sq. Ft.
Type of filter material Total tons used
Minimum Requirements: House Trailer Tank Cap: £300-r Sq. ft. line <. 400
Two-bedroom house ,660 600 -
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
ihereby certify, that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sketah of disposal system on back of sheet and mail to Health Center,;Mocksville»
" X h