1399 Main Church RdDAVIE COUNTY HEALTH DEPART11ENT SEPTIC TANK PERMIT
No of Bedrooms c:;2 . 1,Fi Date 3 --.,7 N'— � 4)
This permit is granted to for the install tWn a sep is tank
at the residence of C_, .�� rh�� c Address W2cc�`
Building Contractor a�1;�,4 -L�x 7 Addre s s
Septic Tank Specificationd,;;' Length Width Depth Capacity Gal.
Manufacturer's Name
Address ` y
No of lines width iii: Total Length %5� ft. No. of Sq. F� G p��
Type of filter material /D UST! __ P Total tons used .16-17
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: U�/
Septic ank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.