2556 Hwy 601SZ66 #AJY&O/-4s ...... � -
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
o. of Bedrooms , Za- Date
''.his permit.; is granted 0o � rt��u> ���_ for the installation of a septic tank -
,at the residence of Address
Building Contractor_ Address_
c61Septic Tank Specifications: Length Width_ Depth Capacity oo Gal.
Manufacturer's Name Address
No. of line s—L—width 11.'F in.
Type of filter material
Total Length p o ft. No. of Sq. Ft. _ (4_ 0o
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 installed according to specifications.
VJ Signed: �✓ -
Septic Tank Contractor
Note: Make sketQ'�'of disposal system on back of sheet and mail to Health Center, Mocksville.
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