P21572 EllisDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms 6' Date d - /S - 9 Z.
This permit is granted to for the inst v lation of a septic tank
at the residence of _ Address /41,
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 'e!�o
Manufacturer's Name Address
No of lines width in. Total Length ft. No. of Sq. Ft. 4� OHO
Type of filter material uz'iI/1ci Total tons used c2 //
Minimum Requirements: House Tr ler Tan's Cap. 800 Sq. ft. line 1+00
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. - D �ti.✓
Signe
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.