P3670 HartnessDA?IE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedrooms 3 Date
This permit is granted to ��il ..% . �'F, for the installation of a septic tank
at the residence of tLIr' o r U -c -ss Address
Building Contractor_j),7AeaC//;fei Address
Septic Tank Specifications: Len Width Depth Ca acity Gal. 00
Manufacturer's Name , � re 00S Address!. �
No of lines_width_3,
4 in. Total Length dc_Qc4 ft. No. of Sq. Ft.
Type of filter material Total tons used
Minimum Requirements: House Tr ler 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:
eptic Tank Contractor � CV -4A__ '„
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.