P2171 Hwy 801S_� , , ,
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-DAVIE COUNTY HEALTH DEPARV1ENT SEPTIC TANK PERMIT
No of Bedrooms 3 Date r,
,7-1-91
This permit is granto for the i lation of aseptic tank
at the residence o 4 Address
Building Contractor aL_�_ Address i
Septic Tank Specific on Length Width Depth Capacity Gal. G�
Manufacturer's Name Address��
No. of lines_ c!y ? , widths, i . Total Length a.Lift. No. of Sq. Ft � Z c.,
Type of filter material Total tons used f�_
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
Officer or his agent.
Date of final approval
tank in Davie County without a permit from the Health
Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications. ,, 1.1
Septic Tank Contractor`
Signed:
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.