P41971 Hwy 158DA`lIE COUNTY HEALTH/ DEPARrHENT SEPTIC TANK PERMIT
No of Bedrooms ' l f4 i r a Date —/ 5— 9
This permit is granted to for the instal tion of a septic tank
at the residence of a Y e Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines width in. Total Length ft. No. of Sq. Ft.
Type of filter material Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq.
Two --bedroom house 800
Three-bedroom house 900
ADu,r /oaa
No one shall install a septic tank in Davie County without a permit
Officer or his agent.
Date of final approval Signed:
ft. line 400
600
900
t Zap
from the Health
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.