1772 Hwy 601S&0(r
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No. of :Bedrooms _ Datev �2 �''' Ln
This permit is granted -Co for the installation of ac ttC-,-,k.
f
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. `��
MFuiufaeturer's Name rC . % , Address -2 ( IfW-
No. of line s_width j in. Total Length Z S- ft. -no. of Sq. Ft.
Type of filter material r/D � �, Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
j Two-bedroom house 800 600
Three-bedroom house 900 900
?10 one shall install a septic tank in
or_his_ agent. _
Date of final approval
Davie 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:
Se c Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.
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