1678 Yadkin Valley RdNo. of Bedrooms e2
DAVIE COUNTY HEALTH DEPARTMENT
SEPTIC TANK PE d,1IT
Date -7-
This permit is granted to the installation
of a Septic Tank at the residence of Address
Building Contractor
Address
Septic Tank Specifications: Length %`b */Width 5.)' Depth k1 Capacity 2± d Gal,
Manufacturer's Name.CJcu u c� �p�c'� Address
No. of lines jddth in. Total length 16-6 ft. No. of Sq.Ft.66¢
Type of filter material RGtt Total tons used ,2 0
Minimum Requirements
House Trailer
Two -Bedroom House
Three -Bedroom House
Tank Capacity
800
800
900
Square Ft. of Line
100
600
900
No one shall install a septic t ank in Davie County w ithout a peri -Lit from the
Health Officer or his agent.
Date of final approbal 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 the Health
Center in Hocksville.