610 Four Corners Rd (3);-11
DAVIE COUNTY HEALTH DEPART114ENT SEPTIC TANK PERMIT
No of Bedrooms I r- q- i /e �`' Date
This permit is granted to fv o n for the installation of a septic tank
at the residence of ,�� J�� Address /f 4 f�
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal.?_
Manufacturer's Name Address 3
No of lines width 13 6 i 511Total Length Z,�ft. No. of q. Ft moo
Type of filter material Z� Total tons used
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
Two --bedroom houm 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 ins alled accordin to
specifications.
Signed: ,L
Septic Tdnk Contractor
Note: Make sketch.of disposal system on back of sheet and mail to Health Center,
Mocksville.