4728 Hwy 158DAVIE COUNTY HEALTH
DEPARTMENT SEPTIC TANK PERMIT
j `o, of Bedrooms
Date
.Fnis permit is granted to
for the installation of a
septic tangy.
at the residence of �, y,,ez'
Address
Building Contractor
Address
Sez,tzc Tank Specifications - Length
Width
Depth Capacity Gal.
a `
� vb
"11cx,ufac. u1•er's Name _ d--�`�- --
Address-/- ' s.
IIo, 01' lines��� width��in. Total
Length
ft, �o. of Sq. Ft.
l�rye of `'-it er material
i1�`^-��,
'Total tons used
'Total
hequirements: House Trailer
Tank
Cap. 800 Sq. ft. line
400
Two-bedroom house
800
600
Three-bedroom house
900
900
No one shall
or his agent.
Date of final
install a septic tank in Davie County -without a permit from the Health Officer
approval
Signed:
Sanitarian
1 heresy certify that the above septic tank has been installed according to specifications.
Signed: e�
Septic Tank Contractor
?dote. Make sketb,. of disposal system on back of sheet and mail to Health Center, Mocksville.
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