P41571 BogerDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms r;z,_ _ _ Date
This permit is granted to %� VWV I N es. Tr -for the installation of a septic tank
at the residence of` q/ yr as aEr �c
� Address j� , 2s4Ar
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines width in. Total Length _�,Sft. No. of Sq. Ft. 160
Type of filter material Total tons used x
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 ove s is tank has been installed according to
specifications.
Signed: '
��—
Skitic Ta ontractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.