P42464 Hwy 158DAVIE COUNTY HLALTH DDPARTUENT
SEPTIC TANK PM-1IT
No. of Bedrooms Date r2 'r -- 6
This permit is granted to r a Zn / or the installation of
a Septic Tank at the residence of�,�: i Address ,j�' a�.� i�,✓/ �± ��
Building Contractor ,df r�-*,:as/, Address
Septic Tank Specifications: Length,, '11idth� Depth Capacity Gal,
Manufacturer's Name � Address
No. of lines_,Widt in. Total length / d a Ft. No. of Sq. Ft. o a
Type of filter material Total tons used`_ .._,.
Minimum Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 400
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 �r�rt S S'r_ ea'� l e- ,/ �z �/ S� ,�+' v �
Septic Tdnk Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.
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