P71670 BogerDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms -13 Date � — Al — i O
This permit is granted to for the in tallation of a sep i c tank
at the residence of ` Address
Building Contracto Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 00 _
Manufacturer's Name Address,3r
No of lines_ width Total Length ft. NO. oT it
Type of filter material —ad:h "_ Total tons used X30
Minimum Requirements: House T&iler 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. VJ41� Signed:V4"UdX
IV Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.