P21871 StarnesDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms 1
3/ Date
This permit is granted to for the installation of a septic tank
at the residence of 5"71;ar-H ..c Address )e�2, t2. C�
Building Contractors _ ,� Address
Septic Tank Specifications: Le gth Width Depth Capacity Gal. v o
Manufacturer's Name c-gs' r c/ 'ZAddress
No of lines_ width 3 in. Tota Leng ,Oft. No. of Sq. Ft. e
Type of filter material e Total tons used
Minimum Requirements: House..Trai r Tank Cap. 800 Sq. ft. line x+00
Tw6=-bedro m 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: --- `
e
Septic Tank ContractoM
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.