1975 Hwy 158 (5)r...._ . ..._ _ . 1 ! ,alp _..., =A�� _ _ .._ `� _ � �'� .. T
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DA`JIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No of Bedrooms ro Date /-/— /? — % /
This permit is granted to Gyt et, for the installa-6 on of a septic tank
at the residence of Address
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal._ 20,0
Manufacturer's Name Address 71
No of lines_ width i . Total Length L2 aa ft. No. of Sq. Ft/ /,,- o -D
Type of filter material Total tons used C>'7- O
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 ccording to
specifications. UL.►
Signed:
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.