P42767 Main Church RdDAVIE COUNTY.HEALTH DEPARTMENT
o, of Bedrooms
'.i. iS permit is granted to
at the residence of
Building Contractor
Septic Tank Specification
Manufacturer's Name
SEPTIC TANK PERMIT
Date oZ % (1119- 6�4�
for the
�jirstallatti of a septic tank'-_
Address
Address
Width___Depth Capacity Gal.
Address
IIS. • of lineswidth 7 -"in. Total LengthOo ft. No. of q. Ft . Zp D D
Type of filter material ? Total tons used
Minimum Requirements: House Trai er Tank Cap. 800 Sq, ft. line 4OG
Two-bedroom house 800, 00
Three-bedroom house 9 900
No one shall install a septic tank in Davie County without a permit from the Health Officer
or his agent.
Daae of final a o�s / t
pproval � L � � . Signed: 4�
Sanitarian
:I hereby certify that the above septic tank has been installed according to specifications.
Signed:
Septic Tank Contractor
Note: Make sketbl. of disposal system on back of sheet and mail to Health Center, Mocksville.
/19 eQ2