333 Deadmon Rd (2) eadmm ec
DAVIE COUNTY HEALTH DEPART11ENT SEPTIC TANK PERMIT
No of Bedrooms7' a%�� r Date S
This permit is granted to Lq m o,�, for the installation of a d, tic tank
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. Oa
Manufacturer's Name Address
No of lines width n. Total Length ft. No. of Sq. F1.. l�fan
Type of filter material Total tons used j
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 led accordin o
specifications.
Signed:
Septic TayK Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
y0.
Yl1 . .._..c.:
f