P71770 Etchison St._ . .
_.....
i� �p i. o S � � �1�
DAVIE COUNTY HEALTH DEPAR^11'1ENT SEPTIC TANK PERMIT
No of Bedrooms p1 Date �---/ 1% — 2 O
This permit is granted to for the installation of a septic tank
at the residence of a Address
rr
Building Contractor ti Address
Septic Tank Specific ions: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines width in. Total Length ft. No. of Sq. Ft. ' 0
Type of filter material �� Total tons used G�?
Minimum Requirements: House Tr filer Tank Cap. 800 Sq. ft. line 100
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.