P33071 Hwy 801.;<sa
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
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No of Bedrooms Date
,This permit is granted to for the install tion f a septic tank
at the residence of Address
Building Contractor Address T— T
4 'Septic Tank Specifications: Length Width Depth Capacity Gal. —
Manufacturer's Name r C�^ ( 1 Address
No of lines_ ,ridth in. Total Length /3`aft. No. of Sq. Ft. 6 d
;,Type of filter material Total tons used o2 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:'J'-kJAJ-L'1A
eptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.