P81671DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms �, t1C I" ( Date. A,94,1-tl
This permit is granted tofc_) fo the install do of a sept'c tan
at the residence of Address
Building Contractor _Z -6b X-?dlff e s s
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name A>-� Address
No of lines_Q width in. Total Length baa ft. No. of Sq. Ft. �'y9
Type of filter material Total tons used
Minimum Requirements: House Trailk, Tank Cap.: 800 Sq. ft. 1 ne 400
Two --bedroom house- 800 600
Three-bedroom house 900 900
No one shall install a septic tank
Officer or his agent.
Date of final approval
in Davie County without a permit from the Health
Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according o
specifications.
Signed/
Septic Tank C
1
Note: Make sketch of disposal system on back of sheet arA mail to Health Center,
Mocksville.