P122871DAVIE COUNTY HEALTH DEPART;IENT SEPTIC TANK PERMIT
No of Bedrooms _ _ — W ,,;_ , Date a — -�
This permit is granted—to 13-1 .-� %,fie, for the installation of a septic tank
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity_ Gal. 4��i
Manufacturer's Name , L \J % 0, ez Address 4/ )01 �}
No of lines width3� in. Total Length ft. No. of Sq. Ft.
Type of filter material Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
Tiro -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. /J
Signed:
Sept c T#k Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.