1313 Ridge Rdr
DAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK PERI,iIT
No. of Bedrooms j Date / �?_ - VG _ 4 S
This permit is granted to e5& for the installation
of a Septic Tank at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length -7 �o I-,Tidth 57,,2- Depth fry /"Capacity Z2_d Gal,
Manuf acturer Is Name Address
No. of lines / IVidth in. Total length I -3V- ft. No. of Sq.Ft.66d
Type of filter material Total tons used
Minimum Requirements:
House 'Trailer
Two -Bedroom House
Three -Bedroom House
Tank Capacity
800
800
900
Square Ft. of Line
400
600
900
No one shall install a septic tank in Davie County without a pernLit from the
Health Officer or his agent.
Date of final approbal Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed ez ._
1
Septic Tank Contractor
Note: I•lake sketch of disposal system on back of sheet and mail to the Health
Center in hocksville.
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