224 Jesse King Rd. .a .
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W Yrs r-1-
b DAVIE COUNTY HEALTH DEPART11ENT SEPTIC TANK PERMIT
No of Bedrooms C;71, Date / D —Z y i 0
This permit is granted toh o,., %/�`S for the installation of a septic tank
at the residence of �s L -k h e_s Address , , _ ✓�kc�
Building Contractor aSP Address
Septic Tank Specifications: Length Width Depth Capacity Gal. a O
Manufacturer's NameAddress
No of lines �2 width .^ Total Length ft. No. of Sq. Ft.
Type of filter material. v Total tons used oZ�
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.