P101370 BrownDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms 2 Date /t) -13 — iQ
This permit is granted to i! ,1, for the installation of a septic tank
at the residence of (_1 /7n Address %1Q
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. j Oo
Manufacturer's Name4 1 i %� a - Address—
No
ddress,No of lines_ width_,f'in. Total Length No. of Sq. Ft.
Type of filter material = R Total tons used 3 0
Minimum Requirements: House Trailer Tank 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 to
specifications.
Signed: z2y,ee�,,yP
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.