P101267 Hwy 901WDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
i•io;,. of Bedrooms 3 Date +
.`.:his permit is granted to for the installation o a septic tank
at the residence of `�ZciyYL Address f �, �tLc�ut��� � % o I�
Building Contractor Address �
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name
'I"� Address
Iao, of lines o`? width--LK-in. Total Length .2 z ) ft. No. of Sq. Ft. o o —1"7.
A
?`c;e of filter material Total tons used
MiniLlum Requirements: Hous Trailer Tank 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.
?klte of final approvalA. s / 2 j I'� 6 i Signed:
' ✓ Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed:
"Z)A'r Septic Tank Contractor
Mote: Make sketi:_'A of disposal system on back of sheet and mail to Health Center, Mocksville,.
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