P92171 Hwy 801SDAVIE COUNTY HEALTH DEPARV1F"ENT SEPTIC TANK PERMIT r �*"
No of Bedrooms C2 , . Date 9 —o-% — V
This permit is grantedto 7?e �,� / �, for the installation of a septic tank
at the residence of Address fid/ - /14 p
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 9eO
Manufacturer I s NameAddress
%� � /� .:���_1 ,•
No of lines_ widthYjlin. Total Length eft. No. of Sq. Ft. ti .D
Type of filter material ' � Total tons used �%�_
Minimum 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 certify that the above septic tank has been installed according to
specifications.
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.