P11766 Farmington RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
o, of Bedrooms Date
:'.his permit is granted to �. for the installation of a septic tank_..
at the residence of a4vy4, Address %�% .
Building Contractor Address
Ser)tic Tank Specifications: Length Width Depth Capacity Gal. 1
Manuf acturer I s Name �- Address C�1,4
No, of lines_ width 34,in. Total Length 3 ob ft. 1o. of Sq. Ft. J
`S,rpe of filter material Total tons used
i+iLnimuir: Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
hree-bedroom house 000 900
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:a� _
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sketb4 of disposal system on back of sheet and mail to Health Center, Mocksville.