166 Dance Hall RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms Date oZ l�-
This permit is granted to �/-n V"s for the installatioof a septic tank
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at the residence of �/� f Address ��: , �n
Building Contractor I��_ Address
Septic Tank Specifications: Length Width Depth Capacity Gal.
Manufacturer's Name Address
No of lines_L width'/�in. Total Length ft. No. of Sq. Ft. yam
Type of filter material Bio Total tons used 3�
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
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.
Signed:11
-�•�%
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.