P71371 MyersDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date
This permit is grant to Lsq }7r-- Por the installation of a eptic tank
at the residence of ' Address �
Building Contractor 4P Addresse^^ �p �(t1 0 p
Septic Tank Specifications: Length Width 'Depth Capacity Gal.
1
Manufacturer's Name 42 Q -C& Address '
No of lines/ width 34 itotal Length Oft. No. of -Sq. Ft. /X
Type of filter material r c s k Total tons :used
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 instglled acco in t
specifications.
Signed:
Septic Tank ontractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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