P3971 Hwy 801SDAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedrooms 1-3 Date ;;,—Z— V
This permit is granted to e r C einrajt for the installation of a septic tank
at the residence of � -$Ll "i" r- Address
Building Contractor 1mg �d�,,t Address r/spines
Septic Tank Specifications: Length Width Depth Capacity Gal. ,49
Manufacturer's Name %, Address Elyl-/ e�c h -s• -
No of lines_ / width V in. Total Length15-Z ft. No. of Sq. Ft. ('00
Type of filter material Total tons used ?t)
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.
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