2234 Hwy 158 (2)DAVIE COUNTY HEALTH DEPARTi1ENT SEPTIC TANK PERMIT
No of Bedrooms_ Iret%�r- Date
This permit is granted to h'. ! K Frj;� for the installation of a septic tank
at the residence of ,r—Address _ /i��r �Z. jk(ecjrs
Building Contractor �rxon er- Address g7�4c,
Septic Tank Specifications: Length Width Depth, Capacity Gal. 4DO
Manufacturer's NametVea,� Address 1 J li-eXik47-evk
No of lines__ width in. Total Length J.:;,54 ft. No. of Sq. Ft. e o
Type of filter material k Total tons used
Minimum Requirements: House Trai er Tank Cap. 800 Sq. ft. line 400
Two --bedroom house 800 u 600
Three-bedroom house 900 goo
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: {�
Septic Tank Contractor
Note: Make sketch of disposal system on,back of sheet and mail to Health Center,
Mocksville.
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