P112869 Sain RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK.PERMIT
No of Bedrooms Date
This permit is granted to y, ~; Ca . for the installation of a septic tank
at the residence of Address
Building Contractor - AddressU�G�1
Septic Tank Specificati ns: Length Width Dept � Capacity Gal.
Manufacturer's Name ca�L:j�. Cz j (-:ib Address�
No of lines_ width_yyin. Total Length x,25 ft. No.' Sq. Ft. J D
Type of filter material - Total tons used
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: ,�j
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.