4323 Hwy 158DAVIE COUNTY HEALTH DEPARTIMENT SEPTIC TANK PERMIT
No of Bedrooms 17 Date --Z - ) - )C>
This permit is granted to &? -�� r for the installation of a septic tank
at the residence of L w Address
Building Contractor J ddress,,�, iQ.s-cam.-�sL
Septic Tank Specifications. Length Width Depth Capacity Gal. b a
Manufacturer's Name L Address ` T 9 '
No of lines, width , �(n i Total Length 3 -,Oft. No . of Sq. t .. 9
Type of filter material /o _ Total tons used 7c)
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
Officer or his agent.
Date of final approval
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` �1 as
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.