P12569 Hwy 158DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
0 cEss%h Date
This permit is granted to %K'i/,'.s for the installation of a septic tank
at the -residence of _ iv =; r, = ::�:, ,> Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. ,0a
Manufacturer's Names _ Address
No of lines c>Z width .1 i . Total Length ft. No. of S . Ft.
- 8 q
Type of filter material Total tons used - o
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
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. ��i Z-�
Signed: ,--�����H
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
,� Mocksville.