P42171DAVIE COUNTY HEALTH DEPARTT4ENT SEPTIC TANK PERMIT
No of Bedrooms Date 1—;2- 7 — 9
This permit is granted to, g ; r ,7; e -a .for the installs on of a septic tank
at the residence of'. Address
Building Contractor ��anp Fogs? r- Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 9 t:>e>
Manufacturer's Name C o e, Address
No of lines width_ in. Total Length a��t. No. of Sq. Ft. gap
Type of filter material _ Total tons used 'Zo
Minimum Requirements:' House,Tra' er Tank Cap. 800 Sq. ft. line 400
-7 Two-bedroom house800 600
Three-bedroom house 900 900
No one shall install a septic tank in Davie County without
Officer or his agent.,
Date of final approval
a permit from the Health
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications. -
Signed: e!�J�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.