P82063DAVIE COUNTY R]ALTH DEPlaT MT
SEPTIC TANK PEM -IIT
No. of Dedrooms L7 Date e
This permit is granted to br.�c,, ��r�/i�?. ��_ for Lfhe installation of
a Septic Tank at the residence of 1C /� Address4i
Building Contractor
—Address-.
Septic Tank Speci cations: Length ,Tidth Depth Capacity Gal
Manuf acturer I s Name &eq- Address
No. of lines I4idth e n. Total length Ft. No. of Sq.Ft.0
Type of filter material �'fQ �� Total tons used S CS
1,iinimmm Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 100
Two-Dedroom House 800 600
Three-Dedroom House 900 900
No one shall install a septic tank in Davie County without a perL-dt 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. y�
Signed _ lZzU.
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in Mocksville.
R 0 AO
II �-�