P1968 Hwy 801N (2)it
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
1o, of Bedrooms _ Date
`1hn�.s permit is granted to for the installation of a septic tanl;
at. the residence of Address Al, 0�2 _171 , 7ya�• �
Building Contractor Address
Septic Tark Specifications: Length Width Depth Capacity Gal.
Mair.facturer's Name Address
I1o,,_ of lines width in. Total Length ft. 1116. of Sq. Ft.
Ty—pe of filter material Total tons used
M."ItniMUM requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 800 600
Three-bedroom house 900 900
??o 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 sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.
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