P111869DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date //— 19 — 6
This permit is granted to 6r" c 44 o
h)►, for the installation of a s ptic tank
at the residence of 9',m Tn L, 1_W Address /
Building Contractor e0 -71-1,S � x A Address eT� �
Septic Tank Specifications: Length Width Depth Capacity Gal. 2 a-;:,-
Manufacturer's Name Address
No of lines �Y[_, width ? �i Total Length .i 5 ft . No. of Sq. F,
Type of filter material -x�/z� �c� �u �i a Total tons used a(�/
Minimum Requirements: House Trailer Tan's 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]
specifications. �.
Signed:
Septic T Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.