198 Greenhill Rd (2)w.. ..y. . _.,. .. .. _ .. ... ...� ....�.. ,.
PE
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Z_rZ, ;-, Date (57 -i3 — Pi'
This permit is granted to, l5 v.'e- T7 d6, for the installation of a septic tank
at the residence of �/ L , j y {�t� coLJ Address /yo (cs v
Building Contractor
Address
Septic Tank Specifications: Length Width Depth Capacity Gal. you
Manufacturer's Name 1�a 5'� 7�_ On r Address _ . _ 1 O CS Cis`
No of lines_ widthin. Total Length ZD, ft. No. of 6q. Ft. r�n�
Type of filter material �,�'- > Total tons used
Minimum Requirements: House Trai er Tank Cap., 800 Sq. ft. line _ Or
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 insta led according to
specifications.
Signed:
eptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.