2696 Hwy 601S (2) 16 fl(W 60(5
T
E COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No, of Bedrooms � Date
This permit is granted to / C/I' e � /C��4&11K for the installation of a septic tank; .
at the residence of Address
Building Contractor _-
Septic Tank Specifications: Length AgZ�Width '__Depth�Capacity ,_Gal. 200
Manufacturer's Name 5ic1 h'1 P Address e
No,. of lines I' widthin. Total Length / 5'0 ft. No. of Sq. Ft. _6 Q V
Type of filter material 5% lox Lf Total tons used '1-0 7-
Minimum
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
o. his agent.
Date of final approval Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to sp cifications.
Signed: ..2JLn0-
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center, Mocksville.
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