1651 County Line Rd._....._. _ .!r_ , _
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms __3 Date , :? , 9
This permit is grant t for the installation of a sept c tank
at the residence of Address `
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. 1 o -o -a
Manufacturer's Name ! ��Address—ZZIXQn `
No of lines_ width Ein. Total Length ft. No. of Sq. Ft. 2n o
Type of filter material Total tons used 117
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
Officer or his agent.
Date of final approval
tank in Davie County without a permit from the Health
Signed: _
Sanitarian
I hereby certify that the above septic tank has been installed according to
specifications.
Signed: S _. � 0
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.