P1970 Hwy 1584 /5-9' �jlqv �
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT '
T':>, of Bedrooms I Date
,!his permit is granted to for the installation of a septic tank.
:it the residence of Address/ 14-)y 15Y fl ere et %P r� _.,
Building Contractor Address
Septic Tani: Specifications: Length Width Depth Capacity Gal.
M nufacturer`s Name Address
Ho.. of lines width in. Total Length
1'y-
.�e of filter material
ft. No. of Sq. Ft.
Total tons used
1initnum Requirements:. House Trailer Tank Cap. 800 Sq. ft. line 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:
Septic Tank Contractor
Note: Make sket h of disposal system on back of sheet and mail to Health Center, Mocksville.
d
��° j