P103168 Hwy 801SDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
°`o, of Bedrooms / c Date
r'his permit is granted to ��c� � - for the installation of a septic tank_
at the residence ofQ`c� �tia-— Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. gds
Manufacturer's NameAddress i
ldo. of lines__Zwidth in. Total Length __L �ft. No. of Sq./Ft/ o -1—
Ty-pe of filter material 17L/ o IN Total tons used _ r
M- nimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line X00
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:4c.s —
Septic Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.
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