203 Edward Beck Rd,I�
DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PER IT
Uo, of Bedrooms Date r — O
'his permit is granted to for the installation of a septic tank_
at the residence of AddressJf"ri
Building Contractor Address
Septic Tank Specificatio Length Width Depth Capacity Gal. a -a
Manufacturer's Name Address
No. of lines width n. Total Length �l0 ft. No. of Sq. F 1,930
Type of filter material �(_ Total tons used 3 03
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 400
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 according to�specifications.
Signed: aed� &c-.& -
Septic Tank Contractor
Note: Make sket'rh of disposal system on back of sheet and mail to Health Center, Mocksville,