126 Twin Cedars Golf RdDAVIE COUNTY HEALTH DEPARTMENT SEPTIC TANK PERMIT _
7r), of Bedrooms 3r T _ Date
"his permit is granted to ./,d e ��" %f%�� for the installationof a se tic tank
,t the residence of ✓ Jpi7`,!/ rY ���� ria Address �l Y� y ,��e 1- �
Building Contractor Address
Septic Tank Specifications: Length- Width /' Depth Capacity Gal.
Manufacturer's Name / v' �' zl-'e-- —7 Address � 1
ho, of lines yidth
_4L2 in. Total Length 5 ft. No. of Sq. Ft. /
7 -pe of filter material 67 ,111ef Total tons used a /
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:
Septic Tank Contractor
Note: Make sket h of disposal system on back of sheet and mail to Health Center, Mocksville.
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