P21169 Hwy 158i
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
Uo. of Bedrooms Date 62
`."his permit is granted to ' for the installation d a septic tank,_.
at the residence of Address
Building Contractor Address_
Septic Tank Specifications: Length Width Depth Capacity Gal. Z JW�D
Manufacturer I s Name J�f� �. L Address ` / ,'_ 5
/ 7
No. of lines width in. Total Length ft. No. o Sq. Ft. ZZ6Z)
Type of filter material In n24:tr Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 40o
Two-bedroom house 800 600
Three-bedroom house 900 900
No one
or his
Date o
shall install a septic tank in Davie
agent.
final approval
County without a permit from the Health Officer
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sket*.a of disposal system on back of sheet and mail to Health Center, Mocksville.
epi