341 Merrells Lake Rd �I�z�l1s Ca,�e 2C/
DA?IE COUNTY HEALTH DEPARV1ENT SEPTIC TANK PERMIT
No of Bedrooms Date 3
This permit is granted t S.%. for the ins allation of a septic tank
at the residence of lN _T Address . r
Building Contractor < -,Addressi�
Septic Tank Specificati ns: Length Width Depth' Capacity Gal. S�?O
Manufacturer's Name ,7'. Address �� �
No of lines_ width in. Total Length ad ft: No. of Sq. Ft.
Type of filter material 4�la Total tons used
Minimum Requirements: House Tra?'�? Tank Cap. 800 Sq. ft. line x+00
Two-bedrodm 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.
Signed; _,A��C
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
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