P5371 Hwy 601S_ [1 .. .. n ... �_.. ... _. ., .. ..w. � .. ...� ..i _.. .1 ,.__.
DAVIE COUNTY HEALTH DEPARTTIENT SEPTIC TANK PERMIT
No of Bedrooms Date —
r
This permit is granted to for the ins al ation of a septic //tank
at the residence of I S�t.1� z r R s- Address lc:L� , yYlf�-zv
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. bzb
c� t
Manufacturer's Name 77 4, r /{Address
No of lines_ width al
(� in. Total Length No. of Sq. Ft.�
Type of filter material Total tons used
Minimum Requirements: House ` Trailer ,--Tank Cap. #V0��5q. ft. line. 400
TWo-�bedroom' house.,.' 800 __ - - 600
Three-bedroom house- 900 900
i
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. r
Signed -7 -[\ •. �-- ke-,. <:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.