P7971 Hwy 601SDAVIE COUNTY HEALTH DEPARTi1ENT SEPTIC TANK PERMIT
No of Bedrooms Aate Q 19 '1
This permit is granted tor►z for the instal at ono a septic tank
at the residence of ( ,for
Building Contractor Address
Septic Tank Specifications: Length Width Depth :Capacity Gal.
Manufacturer's Name Address
No of lines I width 3 iL Total Length 1 tq ft. No. of Sq. Ft.
Type of filter material .t -t1 _ ! Total tons used Z
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.
Signed: .
oe�L - --
tic Tank kontractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.