P51768 County Line RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT
No. of Bedrooms 3 Date r6
This permit is granted to for the irstalla on of a septic tuL
c the residence of Address
i'uilding Contractor 4-nAddress W
Septic Tank Specificatio s: Length Width Depth Capacity Gal.
` Address
Q �!
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No.
,No; of lines ai width '/Yin. Total Length d R ft. No. of Sq. Ft.
T;;rl e of filter material ,�. V ( ____Total tons used
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: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.
Late of final approval
Signed:
Sanitarian
I hereby certify that the above septic tank has been installed according to specifications.
Signed: �c•�-,�' :Zga
Septic Tank Contractor
Note: Make sketb: of disposal system on back of sheet and mail to Health Center, Mocksville„
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