P62871 DysonDAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedrooms r Date
This permit is grante4 to for the Inst 1 on of a se is tank
at the residence of Address
2? '
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Building Contractor _L _Address
Septic Tank Specifications: Length Width Depth Capacity Gal. /a-�r-o
Manufacturer's Name sele� Address
No of lines_ widthin. Total Length o?R_S—h. No. of Sq. Ft. 4DF}
Type of filter material Total tons used LTO
Minimum Requirements: House T146,1er 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: ,0,6p, J
Septic Tank Contractor
Note: :Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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