P22372 WestDAVIE COUNTY HEALTH DEPART11ENT SEPTIC TANK PERMIT
No of Bedrooms 3 Date �' _ — � a
This permit is grant to for the installation of a septic tank
at the residence of 4/71 �-.ss� Addres;�i��'%'L�
Building Contractor q f' eka/r X Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines width in. Total Length ft. No. of Sq. Ft.
Type of filter material Total tons used
Minimum Requirements:" House Trailer Tank Cap. 800 Sq. ft. line 400
Two --bedroom house 8 600
Three-bedroom house Boo
Fw
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:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.