242 Riddle CircleDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of $edrooms'M ; la r , /13 a 44z- -6Y` Date
This permit is grant" to ort(r' for the ids llat
a sept
c tank
the residence of r. Address 1
Znffat
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity
Gal. t4c)MM�
Manufacturer's Name/7---Address1.
No of lines_ width °in. otal Length ,*2a'_ft. No. of
q.
F
Type of filter material ., Total tons
used
Minimum Requirements: House Trai r Tank Cap. 800
Sq.
ft. line
400
Two-�bedro m 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. I
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.