P122565 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK PERMIT
No. of Bedrooms Date /2 _ .2,3r -
This permit is granted to s -" Jz� for the installation
of a Septic Tank at the residence of Address/
Building Contractor Address
Septic Tank Specifications: Length Width 512 /� Depth/,?' Capacity 90 y Com,
Manufacturer's Name ,d eo , Address
ed
No. of lines Udthin. Total length ft. No. of Sq.Ft. � oe
Type of filter material ��J Total tons used -2 6
Minimum Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 100
Two -Bedroom House 800 600
Three -Bedroom House 900 900
No one shall install a septic tank in Davie County w ithout a permit from the
Health Officer or his agent.
Date of final approbal
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed ax�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the Health
Center in Hocksville.
J