4295 Hwy 64WDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
Fio, of Bedrooms Date slams —C9
permit is granted o for the installation of a septic tank_
at the residence of C1 L� _ Address ,%6L� e�
Building Contractor _ Address
Septic Tank Specification _. Length Width Depth Capacity_ Gal.
Afanufacturer's Name L-? Address
Ido. of lines width in. Total Length _ft. Pio. of Sq. Ft.
Type of filter material z otal tons used
Minim -ma Requirements: House Trail r Tank Cap. 800 Sq. ft. line 400
Two-bedroom house 00 600
Three-bedroom house 900 900
No one shall install a septic
or his agent.
Date of final approval
tank in Davie County without a permit from the Health Officer
Signed:
Sanitarian
i hereby certify that the above septic tank has been Inst lled acc/rdi g specifications.
Signed: _
._
ep i Contractor
Note: Make sketbh of disposal system on back of sheet and mail to Health Center, Mocksville.
Al-