P3767 Cates_ DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
_'o, of Bedrooms l� Date '�7
`.'hi:; permit is granted to for the installation of a septic tanb .
ac the residence of L";,*? L�� s Address
Buiading Contractor Address
Septic Tink Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address !>l
No, of. lines__.Lwidth Sr ✓in. Total Length _eft. bio. of7c,. Ft.�oa
Type of filter material;?v� � f/,a Total tons used /-'
Minimiza Requirements: Houser Tank Cap. 800 Sq. ft. line 1+00
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'Ami-If ✓ � 'L' _ 1� � �
Sept' Tank Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.
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