P52570 Calahaln Rd.J.�
DAVIE COUNTY HEALTH DEPART,"1ENT
No of Bedrooms
This permit is granted to for the
at the residence of �ucr�t�_ Address
)2 -
SEPTIC
ZSEPTIC TANK PERMIT
Date
installation of septic tank
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 'lo -c-,3
/Z 0
Manufacturer's Name Address Iff--? -24'�Ar
No of lines width_26 ' / Total Lengthpb ft . No. of Sq. F �, c a 3
Type of filter material Total tons used /c ?n
Minimum Requirements: Houser 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 according to
specifications.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.