115 Danner Rd (4)G
DAVIE COUNTY HEALTH DEPARVIENT SEPTIC TANK PERMIT
No of Bedrooms _ Date
Z/31
This permit is granted to for the in tallest: of a septic tank
at the residence of� L � Address ,S / !1
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. UP
Manufacturer's Name-MAddress
No of lines_ vridth�in. Total Length /8 y"�t. No. of Sq. Ft. �-
Type of filter materiTotal tons used /,S
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 iDIM"t/j,�n
led accoto
specifications.
Signed:�,- ,
eptic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.