P72171 MurrayDAVIE COUNTY HEALTH DEPARTPIENT SEPTIC TANK PERMIT
No of Bedrooms q; fe r' Date ,?1
This permit is granted to a for the ins allation of a septic tank
at the residence of Xel Ou Ir r Address %? ,. S—, c-ksvi ,. 4jL, C.
Building Contractor c�lddress S
�Ae
Septic Tank Specifications: Lengt Width Depth Capacity Gal. co
Manufacturer's Name Address 3
No of lines_ width_,?pin(-'Total Length /Soft. No. of Sq. F 1 a
Type of filter material®)I 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 inst lied acc d'ng
specifications.
Signed:
Septic nk Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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