153 Edgewood Circler-----------------
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DAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
.
No of Seooms Date /o 0
This permit is granted torru" k for the installatiod of a se tic tank
at the residence of 4' Address
Building Contractor Fj`Gmk ' &rnAo /'d7� Address Z3 t54 Sa e., oo/�o�ol" -p
Septic Tank Specifications: Length Width Depth Capacity, ..Gal.
Manufacturer's Name Address
No of lines width in. Total Length ft. No. of Sq. Ft.
Type of filter material Total
Minimum Requirements: House Trailer Tank Cap. 800
Two-bedroom house 800
Three-bedroom house 960.
No one shall install a septic tank
Officer or his agent.
Date of final approval
tons used
Sq. ft. line 1+00
600
900
in Davie County without a permit from the Health
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.