P121869 Hwy 601SDAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
1----� /
No of Bedrooms r� " - Date
This permit is granted, ,to _uAj4 1 (Jb < for the installation of a septic tbnk
at the residence of Address oC
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. C% db
Manufacturer's Name Address.
No of lines�width`_ in. Total Length �'� ft. No. of Sq. Ft. X6'0
Type of filter material-;`iz'��' Total tons used 'oZ
Minimum Requirements: House Trailer, Tana 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 sketch of disposal system on back of sheet and mail to Health Center,
Mocksville..