2589 Liberty Church RdDAVIE COUNTY HEALTH DEPART11ENT SEPTIC TANK PERMIT
No of Bedrooms ., /& .--Date
,� -- ,�
This permit is granted to 7; (.t/, d o ar c �, - for the installation _of a septic tank
at the residence of Address
Building Contractor a rh a rt _�oc3 (o Address & i- "� / lSC,
Septic Tank Specifications: Length Width Depth Capacity GAL.
Manufacturer's Name Address
No of lines width in. Total Length ft. No. of Sq. Ft.
Type of filter material Total tons used
Minimum Requirements: House Trailer, ThLl Cap: �0 Sq. ft. line x+00
Two-bedroom house >' 800 600
Three-bedr6om-house, 900 900
No one shall install a septic tank in Davie County without. -a permit from the Heaith.' �;,
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:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.