P61368 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
Foof Bedrooms Date
"his permit is granted to for the installation of a septic tants...
Address I? AJ �
at the residence of ---
Building ContractorAddress
Sei)tic Tank Specifications: Length Width Depth_ Capacity Gal, Ncm
Manafac user's Name -� Address
bV
Ile, of lines-c_width �r� in. Total Length ? cy ft. No. of Sq.
1`itie of filter material/0 7 •�- Total tons used 3 /
ifiil.iL11"a Requirements: House 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:.
Date of final approval Signed: _
Sanitarian
I hereby cartify that the above septic tank has been installed according to s —cifications.
Signed:
` Septic TE'nk Contractor
Note: Make sketc':: of disposal system on back of sheet and mail to Health Center, Mocksville.