HG SheekDAVIE COUNTY HEALTH DEPARTIMT
SEPTIC TANK PERMIT
No. of Dedrooms 1 Date �� y
This permit is granted to �� o to _:Z1- _ ��p for the installation of
a Septic Tank at the residence of �{_�� /Address
Duilding Contractor Address
Septic Tank Specifications: Length 2LL�Tidth `l Depth_ ( 4e•r Capacity 04 Gal.
Ma.nufacturert s Name,.t : Address /.4, -2
No. of lines+ Width ,�(c in. Total length0 Ft. No. of Sq.Ft._�''d0
Type of filter material _�� Total tons used 170
Minimum Requirements: Tank Capacity Square Ft. of Line
House Trailer 800 100
Two -Bedroom House 800 600
Three-Dedroom House 900 900
No one shall install a septic tank in Davie County vrithout 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 AA�L
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to the
Health Center in M;cksville..