1822 Hwy 64W (2)DAVIE COUNTY HEALTH DEPARL71ENT SEPTIC TANK PERMIT
No of Bedrooms ts'�ry cP_Vk / 'v -YL- Date lt:p , //, a 0
This permit is granted to ,1 ,` for the ins allattioo of a eptic tank
at the residence of /&,lj� Address IC7 /Wpc%S,
Building Contractor Address
Septic Tank Specifications: Length Width Depth Capacity Gal. .;?Do
Manufacturer's Name pts[ v!�! Address
No of lines width_,(< in. Total Length Z Daft. No. of S . Ft.
Type of filter material Total tons usediS�,
Minimum Requirements: House Trailer Tank Cap. 800 Sq. ft. line 1+00
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:&�4� _ -'�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.